Concussion and Balance

How are the two related and How can PT help?

Balance is a complex system that consists of visual input, inner ear equilibrium, and the necessary musculature to keep one upright. This collectively is known as the vestibular system. One can sustain a concussion most commonly when the head strikes a stationary object and additionally in a whiplash situation where the brain is forced against the front and/or back of the skull. This can happen in youth sports or it can be possible during a routine car accident. A concussion is categorized by a larger name known as traumatic brain injury (TBI). What happens to the brain and vestibular system after a TBI?


The CDC estimates that every year approximately 1.5 million Americans suffer at least one traumatic brain injury.  Of those 1.5 million, 28 percent of those are due to falls and 20 percent due to motor vehicle accidents with the rest of the population covering athletics and assault. This means, it is not just youth and sports suffering brain trauma, it individuals of all ages.  When a concussion or TBI has been diagnosed, usually through symptom presentation and the use of standardized testing, in most cases, the vestibular system is disrupted. This can present as dizziness, vertigo, and loss of footing along with other various neurological disturbances.  In many cases, the individual is unaware they have suffered a TBI and will display variations of vestibular compromise while continuing to drive and work. It is very important to recognize even mild dizziness or abnormal feelings after a concussive event so that steps to a safe remediation can be established.


Physical therapy is directly involved with both TBI and the vestibular balance system in order to restore the neurological functioning needed for normal activities, school and work duties. The best treatment for symptoms of concussion involves a physical therapy assessment of vestibular function. A comprehensive vestibular evaluation should include examination of balance activities that involve the vestibular, vision and proprioceptive systems, which reveals the short term damage associated with the concussion. Based on examination findings, specific manual techniques are used to address soft tissue restrictions.  Customized exercises are implemented to focus on balance retraining and return to function activities.  The PT can also refer to a neurologist or specialist if symptoms are noted as red flag and further assessment is needed.  It is imperative that a doctor or health care specialist is involved if a TBI is suspected.  Without assessment, an unresolved concussion can lead to permanent brain damage.

If there are questions associated with traumatic brain injuries or the vestibular system, it is now possible to see a physical therapist without a doctor’s prescription. Intecore Physical Therapy specializes in concussion and vestibular testing and can quickly identify if further evaluation is needed.

– Kristin Timbers, PT, DPT


Andrew Vertson

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