Pediatric Concussion Management: The Role of Physiotherapy
Concussions are increasingly recognized as a serious health concern for children and adolescents across Canada. With growing awareness about the long-term consequences of brain injuries, families in Coquitlam, Port Moody, Port Coquitlam, and Surrey are seeking comprehensive care to support their children's recovery. Physiotherapy has emerged as an essential component of concussion management, offering evidence-based interventions that facilitate safe return to school, sports, and daily activities.
Approximately 1 in 5 sport-related injuries in youth are concussions, making them one of the most common athletic injuries among children and teenagers. Beyond sports, concussions occur from playground accidents, motor vehicle collisions, falls, and other impacts. Understanding how physiotherapy supports recovery can help families navigate this challenging experience and ensure their child receives appropriate care.
Understanding Concussion in Children and Adolescents
A concussion is a type of traumatic brain injury caused by a direct blow to the head, face, or neck, or by an indirect force transmitted to the head. The injury causes biochemical and metabolic changes in the brain that temporarily disrupt normal brain function.
Children are particularly vulnerable to concussions for several reasons:
Their heads are proportionally larger relative to their bodies
Neck muscles are less developed, providing less support
Brain tissue is still developing and may be more susceptible to injury
They may have difficulty recognizing or reporting symptoms
Symptoms vary widely but commonly include headache, dizziness, nausea, difficulty concentrating, sensitivity to light or noise, balance problems, fatigue, and emotional changes. In younger children who cannot articulate their symptoms, parents may notice irritability, changes in sleep or eating patterns, excessive crying, or loss of interest in favorite activities.
The Critical Role of Physiotherapy in Concussion Recovery
Physiotherapy addresses multiple aspects of concussion recovery. While rest immediately following injury is important, prolonged inactivity can actually delay recovery. Research demonstrates that active rehabilitation, guided by physiotherapists, helps children recover faster and more completely than rest alone.
Addressing Physical Symptoms
Many children experience persistent physical symptoms after concussion, particularly headaches, neck pain, and dizziness. These symptoms often respond well to physiotherapy interventions.
Cervical spine assessment and treatment is crucial because whiplash-type injuries frequently accompany concussions. The same force that causes a brain injury often strains neck muscles, joints, and ligaments. Studies indicate that cervical spine physiotherapy can significantly reduce post-concussion headaches and neck pain.
Physiotherapists in the Tri-Cities and Surrey use manual therapy techniques to address joint restrictions and muscle tension in the neck and upper back. They also prescribe specific exercises to restore normal neck movement and strengthen supporting muscles, reducing pain and supporting overall recovery.
Vestibular Rehabilitation
The vestibular system, located in the inner ear, controls balance and spatial orientation. Concussions frequently disrupt this system, causing dizziness, balance problems, and visual disturbances that can persist long after the initial injury.
Vestibular rehabilitation is a specialized form of physiotherapy that retrains the brain to process balance information correctly. Research shows that vestibular physiotherapy significantly improves symptoms and speeds recovery in children with post-concussion vestibular dysfunction.
Treatment includes:
Gaze stabilization exercises that train the eyes to focus while the head moves
Balance training on various surfaces and with different visual conditions
Habituation exercises that gradually expose the child to movements that provoke symptoms, helping the brain adapt
Substitution strategies that teach alternative ways to maintain balance
For a teenager in Port Moody experiencing dizziness when reading or a child in Coquitlam who feels unsteady in busy school hallways, vestibular rehabilitation can provide dramatic symptom relief and restore confidence in movement.
Controlled Exercise Prescription
Current evidence strongly supports sub-symptom threshold aerobic exercise as a key intervention for concussion recovery. Research demonstrates that light aerobic activity, begun early in recovery and gradually increased, reduces recovery time and improves outcomes compared to strict rest.
Physiotherapists conduct specialized exercise testing to determine each child's safe exercise threshold—the level of physical activity they can tolerate without significantly worsening symptoms. Using this baseline, they prescribe individualized exercise programs that typically begin with 15-20 minutes of light aerobic activity such as stationary cycling or walking.
The program progresses gradually, with intensity and duration increased as tolerated. This approach:
Improves cerebral blood flow
Supports metabolic recovery of injured brain tissue
Reduces symptoms of autonomic dysfunction (heart rate and blood pressure irregularities)
Prevents deconditioning during recovery
Supports mental health by maintaining activity levels
Return-to-Learn Protocols: Supporting Academic Success
Academic challenges are among the most common and frustrating consequences of concussion. Children may struggle with concentration, memory, processing speed, and tolerance for cognitive demands. These difficulties can persist for weeks or months, interfering with school performance and causing significant stress.
Physiotherapists play an important role in return-to-learn protocols by:
Assessing Cognitive-Physical Tolerance: Many academic tasks involve physical components—maintaining posture while sitting, moving between classes, tracking text while reading. Physiotherapists evaluate how these physical demands affect symptoms and recommend appropriate accommodations.
Managing Visuo-Vestibular Symptoms: Reading, computer work, and classroom environments with busy visual stimuli can overwhelm a recovering brain. Vestibular rehabilitation helps children tolerate these demands more comfortably.
Optimizing Energy Management: Physiotherapists teach pacing strategies that help children balance cognitive and physical activities throughout the school day, preventing symptom escalation.
Collaborating with Schools: In Coquitlam, Port Moody, Port Coquitlam, and Surrey, physiotherapists often communicate with school personnel to recommend evidence-based accommodations such as reduced workload, extended time for assignments, frequent breaks, modified physical education, and adjustments to the sensory environment.
Return-to-learn typically follows a graduated protocol:
Daily activities at home that don't worsen symptoms
School-related activities at home (reading, homework) starting at 5-15 minutes
Partial return to school with accommodations
Gradual increase in school attendance and workload
Full return to school without accommodations
Movement through these stages depends on symptom response, with progression occurring when the child tolerates each level without significant symptom exacerbation.
Return-to-Play Guidelines: Safe Sports Resumption
For young athletes in the Lower Mainland, returning to sports safely after concussion is a primary concern. Premature return risks repeat injury, which can have devastating consequences. Second impact syndrome, though rare, can occur when an athlete sustains another concussion before recovering from the first, potentially causing severe brain swelling and even death.
Physiotherapists guide athletes through evidence-based return-to-sport protocols that ensure complete recovery before full participation. The standard protocol includes six progressive stages:
Stage 1: Symptom-Limited Activity: Light daily activities that don't provoke symptoms. The child may do light walking or stationary cycling at low intensity.
Stage 2: Light Aerobic Exercise: Progressive aerobic exercise at moderate intensity (target heart rate 60-70% maximum), with no resistance training. Activities might include jogging, swimming, or stationary cycling for 15-30 minutes.
Stage 3: Sport-Specific Exercise: Movement drills and moderate intensity training without contact or collision risk. A soccer player in Surrey might practice dribbling drills. A hockey player in Coquitlam might work on skating patterns. No activities involve risk of head impact.
Stage 4: Non-Contact Training Drills: Progression to more complex training and coordination exercises. Full training activities without contact, including progressive resistance training.
Stage 5: Full-Contact Practice: Normal training activities including controlled contact (with medical clearance). This allows coaching staff to assess functional skills and readiness.
Stage 6: Return to Play: Normal game competition.
Each stage typically requires 24 hours minimum before progression. If symptoms return at any stage, the athlete rests until symptom-free, then resumes at the previous stage. Physiotherapists monitor progression, adjust exercise prescriptions, and communicate with coaches, athletic therapists, and physicians.
Importantly, children should not return to sports until they have successfully returned to full academic activities. The brain needs to demonstrate it can handle cognitive demands before adding the complexity and physical stress of athletic competition.
Special Considerations for Female Athletes
Growing evidence indicates that female athletes may experience concussions differently than males. Research suggests that females report more symptoms, have longer recovery times, and experience different symptom profiles.
Hormonal fluctuations may influence concussion recovery. Some studies indicate that injuries occurring during certain phases of the menstrual cycle may result in worse outcomes. For teenage girls in Port Moody and Coquitlam, physiotherapists consider these factors when designing treatment programs and setting recovery expectations.
Female athletes also face unique challenges with diagnosis, as they may be more likely to report symptoms but also face pressure to minimize injuries. Creating an environment where reporting symptoms is encouraged and supported is essential.
Pregnancy and Concussion Considerations
While less common, women may experience concussions during pregnancy from falls, motor vehicle accidents, or other impacts. Pregnancy complicates concussion management because:
Many diagnostic imaging tests are avoided during pregnancy
Some medications used for symptom management may not be safe
Balance changes during pregnancy can increase fall risk
Hormonal changes may affect recovery
Physiotherapy offers particularly valuable support for pregnant women with concussions because it provides non-pharmacological treatment options. Vestibular rehabilitation, manual therapy for neck pain, and guided exercise can all be performed safely throughout pregnancy. Physiotherapists in the Tri-Cities and Surrey can adapt protocols to accommodate pregnancy-related changes while supporting concussion recovery.
Postpartum women who sustained concussions before or during pregnancy may find that caring for an infant presents unique challenges. Sleep deprivation can worsen concussion symptoms, while the physical demands of infant care may exceed symptom tolerance. Physiotherapists can help by teaching energy conservation strategies, modifying activities, and providing graduated exercise programs that support recovery while accommodating parenting demands.
When to Seek Physiotherapy for Concussion
Families should consider physiotherapy assessment when:
Symptoms persist beyond 10-14 days after injury
A child experiences significant headaches, neck pain, dizziness, or balance problems
Visual symptoms interfere with reading or screen time
Academic performance declines after concussion
Return to sport is delayed due to persistent symptoms
A child has sustained multiple concussions
There are concerns about prolonged recovery
Early physiotherapy intervention, ideally within the first few weeks after injury, is associated with better outcomes. However, physiotherapy remains beneficial even for individuals experiencing symptoms months or years after concussion.
Preventing Concussions and Repeat Injuries
While some accidents are unavoidable, physiotherapists in Coquitlam, Port Moody, Port Coquitlam, and Surrey help families reduce concussion risk through:
Neck Strengthening Programs: Stronger neck muscles may reduce concussion risk by stabilizing the head during impacts. Targeted strengthening programs are particularly beneficial for athletes in contact sports.
Sport-Specific Training: Proper technique in sports like heading a soccer ball, hockey checking, or rugby tackling can reduce injury risk.
Balance and Proprioception Training: Better balance and body awareness may help athletes avoid collisions and reduce fall risk.
Education: Teaching children, parents, and coaches to recognize concussion signs and symptoms ensures prompt identification and appropriate management, preventing repeat injuries due to premature return to activity.
The Multidisciplinary Approach to Concussion Care
Optimal concussion management involves collaboration among multiple healthcare providers. Physiotherapists work alongside:
Family physicians and pediatricians who provide initial diagnosis and medical oversight
Sport medicine physicians who specialize in concussion management
Neurologists for complex or prolonged cases
Occupational therapists who address cognitive and daily living skill challenges
Psychologists or counselors who support mental health during recovery
Athletic therapists and trainers who oversee return to sport
School personnel who implement academic accommodations
In the Lower Mainland, many clinics offer integrated concussion programs where these professionals collaborate to provide comprehensive care. This team approach ensures all aspects of recovery are addressed and families receive consistent guidance.
What to Expect from Concussion Physiotherapy
When a family seeks physiotherapy for concussion in the Tri-Cities or Surrey, the process typically includes:
Comprehensive Assessment: The physiotherapist reviews the injury history, current symptoms, and how they impact daily activities. Assessment includes cervical spine examination, balance testing, visual and vestibular screening, exercise tolerance testing, and evaluation of any functional limitations.
Education: Understanding concussion recovery empowers families to make informed decisions. Physiotherapists explain the injury, expected recovery timeline, and the rationale for treatment recommendations.
Individualized Treatment Plan: Based on assessment findings, the physiotherapist designs a program addressing specific impairments. This might include vestibular rehabilitation, cervical spine treatment, progressive exercise prescription, and strategies for managing symptoms during activities.
Progressive Rehabilitation: Treatment progresses as symptoms improve. Regular reassessment tracks recovery, guides progression, and identifies any complications requiring referral to other specialists.
Return-to-Activity Support: Physiotherapists guide progression through return-to-learn and return-to-play protocols, communicating with schools, coaches, and other providers to ensure coordinated care.
Moving Forward After Concussion
Most children recover fully from concussions within 4-6 weeks with appropriate management. Physiotherapy plays a vital role in this recovery by addressing physical symptoms, supporting safe return to activities, and preventing complications.
For families in Coquitlam, Port Moody, Port Coquitlam, and Surrey navigating concussion recovery, seeking care from physiotherapists with specialized training in concussion management ensures their child receives current, evidence-based treatment that supports complete recovery and safe return to all the activities they love.
References
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Schneider, K. J., Leddy, J. J., Guskiewicz, K. M., et al. (2017). Rest and treatment/rehabilitation following sport-related concussion: a systematic review. British Journal of Sports Medicine, 51(12), 930-934. https://bjsm.bmj.com/content/53/4/213
Reneker, J. C., Hassen, A., Phillips, R. S., Moughiman, M. C., Donaldson, M., & Cook, C. E. (2017). Feasibility of early physical therapy for dizziness after a sports-related concussion: a randomized clinical trial. Scandinavian Journal of Medicine & Science in Sports, 27(12), 2009-2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5434562/
Leddy, J. J., Haider, M. N., Ellis, M. J., et al. (2019). Early subthreshold aerobic exercise for sport-related concussion: a randomized clinical trial. JAMA Pediatrics, 173(4), 319-325. https://pubmed.ncbi.nlm.nih.gov/30715125/
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