Feeling “Off Balance” Post Concussion

Assessment and treatment of concussions involves a multi-faceted approach in which many systems are examined and treated. An important area to address post concussion is  the vestibular system, which plays an essential role in balance, coordinating movement and spatial orientation. However, it doesn’t work entirely alone. It interacts with the visual system and proprioceptive receptors in muscles and joints, which together send messages to the brain to help achieve and maintain balance and stability as we move through daily activities. Following a concussion there can be direct/indirect damage to any of the systems, which may result in the person feeling off balance, dizzy, nausea, spinning, lightheaded or disorientated. Research has suggested that anywhere from 23-81% of patients will experience one or more of the above symptoms post concussion. Furthermore, these symptoms may be a risk factor for prolonged recovery and can persist in 10-30% of patients. The most common complaint related to dizziness following a concussion is feeling “off balance.” These symptoms are perfectly normal post concussion and can be treated with vestibular rehabilitation.

Vestibular rehabilitation is a key management technique for getting concussed patients back to feeling normal. At Sheddon Physiotherapy and Sports Clinic (SPSC), concussed patients suffering from dizziness and imbalance are thoroughly assessed in order to determine which aspect of the vestibular system is affected. Due to the complexity of the balance system, assessment also includes the visual system (read our past blog here regarding visual rehabilitation), proprioceptive receptors, as well as the integration of all three systems.

From the assessment, patients will be given a treatment approach and exercise program tailored to their individual needs. Exercises may include simple eye-head coordination exercises, visual rehab, static and dynamic balance, ambulation tasks and symptom habituation exercises. A key feature with these exercises is that patients may often feel worse before they feel better, which is counter-intuitive to why they are seeking your help. In most cases, the brain has to learn to compensate in order for your symptoms to improve. Therefore, if you avoid the activities that make you dizzy, you generally will not get better. Having said that, more isn’t better either. Your assessment findings will help your therapist determine how much and how often you should be doing your exercises. Everyone is different and your program will progress as your symptoms improve. 

If you have suffered a concussion and can’t shake the feeling of dizziness and feeling off balance, contact one of the therapists at SPSC in order to assess and treat these symptoms. If you haven’t suffered a concussion, but have any of the above symptoms, vestibular rehabiliation can also work for you (it’s not just for concussed patients). Read our past blog here on living with dizziness.