Coming Back From A Concussion: Rehab And Recovery

Recovering from a concussion isn’t as simple as “walking it off.” Unlike other injuries, pushing through symptoms or returning too soon can make things worse. Concussions need a careful, step-by-step approach to healing and with the right support, most people make a full recovery.

Activities That Can Worsen Concussion Symptoms

Concussions affect the brain, so anything that overstimulates it can worsen symptoms.

“Think about how a concussion is a brain injury. When you do things that cause you to use your brain too much, that’s when you can worsen the injury,” said Blake Averill, DO, a sports medicine physician who practices at Franciscan Physician Network Sports Medicine Specialists Stones Crossing. “It can be something as simple as a Chromebook or iPad at school. It can be gym, band or choir. Anything that stimulates the brain can make symptoms worse.”

Dr. Averill said overstimulation isn’t limited to student-athletes. Adults often struggle too. “I see a lot of adults with these issues. It might be someone who slipped off a ladder, or someone in a car accident. For them, it might be giving a presentation at work or finishing a big project.”

Symptoms don’t always appear immediately. “That’s why we pull people out of those stimulating environments for a short time, maybe 24 to 48 hours, just to see how severe their symptoms are,” Dr. Averill said.

Why Concussion Treatment Matters

In the past, patients were told to rest in a dark room until symptoms went away. But newer research shows that approach, called cocoon therapy, can actually make recovery worse.

“The old treatment was cocoon therapy — rest until symptoms are gone, then begin therapy. We’ve learned that’s the worst thing you can do for concussions,” said Craig Voll, PhD, PT, a Franciscan Health sports medicine athletic trainer.

Just as we wouldn’t expect a broken bone to heal perfectly without proper medical attention, the brain requires targeted care to mend itself fully after a concussion. Ignoring the need for post-concussion treatment can be like leaving a fracture untreated: the consequences may be long-lasting.

Sometimes concussions require therapy to help the brain fully recover. Treatment may include balance therapy, ocular training, cognitive training and cervical spine therapy.

It’s important to use a team of specialists, from therapists to physicians, to address the physical, cognitive and emotional symptoms of a concussion.

“We are always exploring and implementing new and evolving therapies,” said Sachin Mehta, MD, a physical medicine and rehabilitation physician who practices at Franciscan Physician Network Rehabilitation and Spine Specialists Indianapolis.

Rehabilitation Therapies For Concussion

While mild concussions often improve with rest, post-concussion syndrome can last much longer and disrupt daily life. A multidisciplinary program that combines neurology, concussion rehabilitation and therapy specialists gives patients the best chance for recovery, with each expert addressing different symptoms.

Physical therapy

Brad Keck, a physical therapist at Franciscan Health Indianapolis, explained that concussions often fall into categories such as primary headache, primary dizziness, or emotional-cognitive concussions.

“If a patient had migraines before the concussion or emotional-cognitive problems such as ADHD [attention-deficit hyperactivity disorder], PTSD [post-traumatic stress disorder], anxiety or depression, those conditions can worsen,” he said.

Physical therapy often addresses neck and cervical spine issues that contribute to headaches. “We perform different treatment approaches to reduce cervical strain, neck strain and muscle tension to potentially improve headaches,” Keck said.

Physical therapy also helps patients manage sensory overload and disorientation. “For example, students in choir or band, or even in noisy hallways, can experience overload. We work with them on strategies to control sensory input so it doesn’t disorient them.” Balance problems are often addressed alongside this therapy.

Occupational therapy

“Some people think occupational therapy just means returning to work, but it’s really about the things that occupy your time and are important to you,” said Johanna Dix, OT. “Our goal is to get people back to the functional things in their life and help them be independent again.”

Occupational therapists create accommodations for students and workers, such as adjusted schedules or modified assignments, to help prevent setbacks. They also design graduated return-to-work or return-to-school programs.

“We don’t want people to jump back full-time if they still have lingering symptoms,” Dix said. “That can overload the brain and slow healing.”

Vision therapy

Dix said concussions often cause visual issues, such as double vision, blurred vision, poor eye tracking, eye strain, light sensitivity or depth perception problems.

“We’ve developed a vision rehab program within occupational therapy,” she said. “We have specific treatments for binocular vision deficits, where one eye is not working in sync with the other. Once vision improves, the brain receives better information — and it makes a big difference.”

Speech therapy

Speech therapy is important in recovery, even if a patient doesn’t have speech problems.

“Some may not realize what a speech therapist does in this setting,” said Kayla McConnell, speech-language pathologist at Franciscan Health. “We work on cognition, memory, attention, executive functioning, language and organization.”

McConnell explained that cognitive fatigue is common. Patients may be able to complete tasks, but the mental effort required is far greater than before. “Your cognition will often follow your physical and mental health,” she said. “If you’re having a tough day physically, you’re likely to have a tough day cognitively.”

Expected Recovery Timeline

The concussion recovery timeline is different for each person, but most patients improve within weeks.

“For adults, the majority recover within two to three weeks. Children and adolescents take a little longer, closer to four weeks on average,” Dr. Averill said. “But some people have symptoms for three months, six months or even a year. That’s why we encourage people to come in early, because we have specialized therapies that can help.”

Dr. Mehta said the old approach of total rest has shifted to a more active recovery. “If you’re in bed too long, you get weak, you fall behind at school or work, and depression or anxiety can worsen. Research shows that low-level physical and mental activity — walking, light exercise, returning to school with accommodations — actually speeds recovery.”

Dix added that progress can be dramatic. “It’s amazing to see patients who were incredibly dizzy improve after just a couple of physical therapy sessions,” she said.

Returning To Sports

If you suspect a concussion, the child should never return to play the same day. Both the American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend sitting out until cleared by a physician.

“After you take this impact to your brain, you get some swelling,” said Matthew Rachwalski, DO, a sports medicine physician who sees patients at Franciscan Physician Network Coolspring Health Center. “Going back too soon, when the brain is still swollen, can lead to permanent damage or, in severe cases, death. That’s why we take it so seriously.”

Concussions may seem invisible, but recovery takes care and patience. With early concussion rehabilitation and Franciscan Health’s team-based approach, patients can get back to school, work, sports and life more safely. If symptoms continue beyond the usual recovery period, learn more about post-concussion syndrome and long-term risks.

Request an appointment or learn more about concussion therapy at Franciscan Health.