Post-concussion syndrome (PCS) occurs when concussion symptoms persist beyond the typical recovery period, often causing significant disruption to daily life. Understanding PCS and following evidence-based recovery strategies can help you get back to your normal activities. At M.O. Therapy in Markham, we provide specialized care for patients recovering from concussion and post-concussion syndrome.
Understanding Post-Concussion Syndrome
What Is Post-Concussion Syndrome?
Post-concussion syndrome refers to a collection of symptoms that persist for weeks, months, or even longer after an initial concussion. While most concussions resolve within 2-4 weeks, some individuals experience prolonged symptoms.
Definition:
- Symptoms persisting beyond expected recovery time
- Typically defined as symptoms lasting more than 4 weeks
- Can persist for months or longer
- Affects 10-30% of concussion patients
Who Is at Risk?
Risk Factors for Prolonged Recovery:
- History of previous concussions
- History of migraines
- Pre-existing anxiety or depression
- Learning disabilities
- Female sex
- Age (adolescents and older adults)
- Severity of initial symptoms
- Initial rest too strict or not enough
Common Symptoms
Physical Symptoms
Headaches:
- Most common PCS symptom
- May be constant or intermittent
- Various types (tension, migraine-like)
- Can be triggered by activity
Dizziness and Balance:
- Feeling lightheaded
- Balance problems
- Vertigo
- Motion sensitivity
Visual Problems:
- Blurred vision
- Light sensitivity
- Difficulty focusing
- Eye strain
- Tracking difficulties
Other Physical:
- Fatigue
- Sleep disturbances
- Noise sensitivity
- Nausea
Cognitive Symptoms
"Brain Fog":
- Difficulty concentrating
- Memory problems
- Slow processing speed
- Difficulty multitasking
- Word-finding difficulties
Mental Effort:
- Tasks require more effort
- Quick mental fatigue
- Difficulty with complex thinking
- Reduced mental stamina
Emotional Symptoms
- Irritability
- Anxiety
- Depression
- Mood swings
- Feeling overwhelmed
- Emotional sensitivity
Diagnosis and Assessment
Comprehensive Evaluation
Medical History:
- Details of injury
- Symptom timeline
- Previous concussions
- Pre-existing conditions
- Current medications
Symptom Assessment:
- Standardized symptom scales
- Tracking symptom severity
- Identifying patterns
- Trigger identification
Physical Examination:
- Neurological testing
- Vestibular assessment
- Oculomotor (eye movement) testing
- Cervical spine evaluation
- Balance testing
Imaging
When Needed:
- Ruling out structural damage
- MRI typically normal in PCS
- Specialized imaging may show subtle changes
- Not required for diagnosis
Treatment Approaches
Active Rehabilitation
Modern Approach: Research now supports active rehabilitation rather than prolonged rest:
- Controlled return to activity
- Graduated exercise
- Symptom-limited activity
- Individualized progression
Why Active Recovery:
- Promotes brain healing
- Prevents deconditioning
- Reduces anxiety and depression
- Improves blood flow to brain
Sub-Symptom Threshold Exercise
Aerobic Exercise Protocol:
Assessment:
- Buffalo Concussion Treadmill Test
- Identifies symptom threshold
- Guides exercise prescription
Program:
- Exercise below symptom threshold
- Start at 80% of symptom threshold
- Progress as tolerated
- Daily or near-daily exercise
Example Progression:
- Week 1: 15 minutes at low intensity
- Week 2: 20 minutes, slight intensity increase
- Continuing progression based on symptoms
Vestibular Rehabilitation
For Dizziness and Balance:
Vestibular therapy addresses:
- Dizziness
- Balance problems
- Motion sensitivity
- Visual-vestibular mismatch
Techniques:
- Gaze stabilization exercises
- Balance training
- Habituation exercises
- Functional movement training
Vision Therapy
For Visual Symptoms:
May include:
- Eye movement exercises
- Focusing exercises
- Visual tracking work
- Convergence training
Cervical Spine Treatment
Neck Contribution:
The neck can contribute to PCS symptoms:
- Headaches
- Dizziness
- Visual disturbances
Treatment:
- Manual therapy
- Strengthening exercises
- Postural correction
- Movement retraining
Headache Management
Approaches:
- Identify triggers
- Medications (if needed)
- Physical therapy
- Lifestyle modifications
- Stress management
Cognitive Rehabilitation
For Mental Symptoms:
- Cognitive exercises
- Compensatory strategies
- Return-to-work/school planning
- Gradual increase in mental demands
Psychological Support
Mental Health Care:
- Address anxiety and depression
- Cognitive behavioral therapy
- Stress management
- Coping strategies
- Support groups
Return to Activity
Return-to-Sport Protocol
Six-Stage Progression:
Stage 1: Symptom-Limited Activity
- Light walking
- Below symptom threshold
- Daily activities
Stage 2: Light Aerobic Exercise
- Walking, swimming, stationary cycling
- No resistance training
- Low intensity
Stage 3: Sport-Specific Exercise
- Running drills
- Skating drills
- No head-impact activities
Stage 4: Non-Contact Training
- Harder training
- Coordination exercises
- Resistance training
Stage 5: Full-Contact Practice
- Normal training activities
- After medical clearance
Stage 6: Return to Competition
- Full participation
- Only after completing all stages
Return to Work/School
Similar Graduated Approach:
- Start with reduced hours/load
- Quiet environment initially
- Frequent breaks
- Gradual increase in demands
- Accommodations as needed
Lifestyle Management
Sleep
Essential for Recovery:
- Consistent sleep schedule
- Adequate sleep duration
- Good sleep environment
- Address sleep disturbances
Stress Management
- Reduce stressors when possible
- Relaxation techniques
- Mindfulness practices
- Support system
Screen Time
- May need initial reduction
- Gradual reintroduction
- Take frequent breaks
- Adjust brightness and settings
Activity Pacing
- Balance activity and rest
- Avoid boom-bust cycle
- Gradual increases
- Listen to your body
Red Flags
Seek immediate medical attention for:
- Worsening headache
- Repeated vomiting
- Seizures
- Confusion or disorientation
- Weakness or numbness
- Slurred speech
- Changes in consciousness
Treatment at M.O. Therapy
Physiotherapy
Our physiotherapists specialize in concussion recovery:
Assessment:
- Comprehensive evaluation
- Vestibular screening
- Cervical spine assessment
- Exercise tolerance testing
Treatment:
- Graduated exercise program
- Vestibular rehabilitation
- Cervical spine treatment
- Return-to-activity guidance
Massage Therapy
Our RMTs help with:
- Headache relief
- Neck tension
- Relaxation
- Sleep improvement
Chiropractic Care
May include:
- Cervical spine assessment
- Gentle treatment
- Soft tissue therapy
- Movement optimization
Recovery Outlook
What to Expect
Most Cases:
- Symptoms improve over time
- Active rehabilitation helps
- Full recovery is typical
- May take weeks to months
Factors for Good Recovery:
- Early active treatment
- Graduated exercise
- Proper sleep
- Stress management
- Support system
- Patience and persistence
Frequently Asked Questions
How long does post-concussion syndrome last? Recovery time varies significantly. Most people see substantial improvement within 3-6 months with proper treatment. Some cases may take longer. Active rehabilitation typically speeds recovery.
Should I rest completely with PCS? No, prolonged complete rest is no longer recommended. Controlled activity within symptom limits is now the standard approach and promotes better outcomes.
Can exercise make PCS worse? Exercise above your symptom threshold can temporarily worsen symptoms. However, sub-symptom threshold exercise actually helps recovery. Working with a professional helps ensure appropriate intensity.
Will I fully recover from PCS? Most people with PCS do fully recover, especially with appropriate treatment. Early active rehabilitation, addressing all contributing factors, and patience are key to optimal outcomes.
Book Your Assessment
If you're experiencing persistent symptoms after a concussion, M.O. Therapy in Markham can help. Our team provides specialized concussion rehabilitation to support your recovery.
Call (905) 201-5827 or book online for your assessment. We offer direct billing and same-day appointments.