Physiotherapy Approaches for Traumatic Brain Injury Recovery

A Traumatic Brain Injury (TBI) may alter your movements, thoughts, sleep and your ability to cope with activities in your daily life. Regardless of whether the injury is mild (also known as a concussion) or moderate-to-severe, the recovery is unlikely to be straightforward: there will be good days, tough days, and slow improvement over time.

Physiotherapy is important since numerous symptoms of TBI manifest in the body’s balance, dizziness, neck pain, strength, coordination, endurance, and confidence as one moves through life again.

1) Start with a thorough, symptom-led assessment

Good rehab begins with identifying your drivers. A physiotherapy assessment after TBI typically looks at:

• Balance and gait (walking pattern, steadiness, fall risk)

• Vestibular function (inner-ear balance system: dizziness, vertigo, unsteadiness)

• Vision-vestibular interaction (eye tracking, focusing, tolerance to screens and busy environments)

• Neck involvement (common after concussion; can contribute to headaches and dizziness)

• Power, coordination, reaction time and stamina

• Tolerance to exertion (symptoms on exerting more of the heart rate or activity)

• Functional objectives (going back to school, employment, sport, driving, parenting, and daily living)

This test will assist us in developing a plan which is both specific and measurable, and at a pace that your nervous system can handle at the moment.

2) Early-stage rehab: calm the system, restore safe movement

For many people, especially after a concussion, rehab starts with stabilizing symptoms and restoring basic tolerance. That may include:

• Education and pacing: Learning how to balance activity and rest so you’re not stuck in a “boom-bust” cycle

• Gentle mobility and walking: Reintroducing movement without flaring symptoms

• Breathing strategies and posture work: Helpful for headaches, neck tension, and overall regulation

• Sleep and routine support: Not “physio exercises” per se, but essential for recovery momentum

In moderate-severe TBIs, early physio can be targeted more toward bed mobility, safe walking and prevention of secondary complications.

3) Sub-symptom aerobic exercise: rebuild endurance safely

Among the most significant changes to the current concussion treatment is the abandonment of the concept of extensive rest. Sub-symptom aerobic exercise (exercise that does not exceed the threshold that induces symptoms) can be administered carefully to enhance exercise tolerance and facilitate recovery. This might look like:

• Stationary cycling or treadmill walking

• A heart-rate or symptom-guided program

• Gradual progression in time and intensity

The goal isn’t to “push through.” It’s to train the brain and body to tolerate activity again, step by step.

4) Vestibular and balance rehabilitation: for dizziness, motion sensitivity, and unsteadiness

Dizziness after a TBI can come from multiple sources: vestibular system changes, neck issues, visual processing, or a combination. Vestibular rehab is an exercise-based approach that may include:

• Gaze stabilization exercises (training eye-head coordination)

• Habituation (gradual exposure to movements that trigger symptoms)

• Balance and walking drills (including uneven surfaces, turns, dual-task walking)

We also make arrangements with other providers (e.g., optometry/vision therapy, medical teams) when the symptoms are indicative of a visual or neurological contribution that can not be dealt with by physio alone.

5) Cervical (neck) physiotherapy: headaches, dizziness, and “post-concussion neck”

After falls, sports impacts, or vehicle collisions, the neck often takes a hit too. Neck dysfunction can refer pain into the head and contribute to dizziness or fogginess. Physiotherapy may include:

• Manual therapy and joint/soft-tissue techniques (when appropriate)

• Range-of-motion and deep neck stabilizer retraining

• Posture and ergonomic coaching

• Gradual return to lifting and daily tasks

Treating the neck can be a missing puzzle piece, especially when headaches linger.

6) Strength, coordination, and return-to-function training

As symptoms settle and tolerance improves, rehab becomes more performance-based:

• Strength and conditioning for legs, hips, trunk, and upper body

• Coordination and agility work (as appropriate to your goals)

• Task-specific practice: stairs, carrying, reaching, getting up from the floor, workplace tasks

• Dual-task training: combining movement with thinking (common challenges after TBI)

This is where rehab becomes highly individualized. “Ready to return” is less about a calendar date and more about meeting clear functional markers safely.

7) Return-to-sport / return-to-activity: gradual, supervised progression

For athletes, gradual recovery is important. Many guidelines prioritize gradual, progressive improvement. Symptoms should be observed at every step, and proceeding with the next step should be allowed only when it is perceived as tolerable. There is normally a 24-hour interval between steps, and any symptom escalation requires reassessment and reversal. We also take into account return-to-learn strategies for student-athletes to ensure that school requirements do not compromise recovery.

FAQs

1) How long does TBI recovery take?

It varies widely. Symptoms of concussions may resolve in several days to weeks, though other cases are slow to resolve, particularly when the concussion is accompanied by vestibular, neck, sleep or mood issues. Moderate-to-severe TBI recovery may take months or years with continuous improvements. A progressive program with frequent re-checks is the most effective strategy.

2) Should I rest completely after a concussion?

A little relative rest in the beginning may work, but long periods of overall rest may not be the solution. Most individuals respond better to symptom-restricted activity and progressive reconditioning.

3) Can physiotherapy help with dizziness after TBI?

Often, yes, especially when dizziness is related to vestibular dysfunction, balance deficits, or cervical involvement. A targeted assessment helps determine which system is driving symptoms.

4) What if exercise makes my symptoms worse?

That’s common early on. The goal is to find your safe starting level (below symptom flare) and build gradually. If symptoms spike significantly or don’t settle, your program needs adjusting, not brute force.

5) When can I return to sport, gym, or work?

Return is usually step-by-step, based on symptom stability and functional testing, not just time since injury. Your physiotherapist can coordinate with your physician and (when relevant) coaches/employers to build a safe plan.

A Supportive Next Step With Sahara Health

Our team at Sahara Health is focused on in-depth assessments, effective goal-setting, and gradual rehabilitation strategies that focus on your symptoms and lifestyle, whether you have post-concussion dizziness, limited endurance, or even headaches. In case you are not certain about where to begin, you can schedule a free consultation, and we will guide you on the way forward in a practical sense.