Concussion

Introduction

A concussion is a mild traumatic brain injury that can happen after a knock to the head, a fall, or even a sudden jolt to the body that causes the brain to move inside the skull. It’s far more common than most people realise — research estimates that around 42 million concussions occur worldwide each year, with many going undiagnosed, especially in sport and everyday accidents.

Symptoms such as headaches, dizziness, fatigue, blurred vision, or feeling mentally “foggy” can make work, exercise, and daily tasks far more challenging than expected. The reassuring news is that concussions usually recover very well with the right guidance, gradual return to activity, and physiotherapy support.

Anatomy & Biomechanics

The brain is a soft, highly active organ that sits inside the skull, protected by fluid and membranes. It is well designed to cope with normal movement, but rapid acceleration, deceleration, or rotational forces — such as a fall, collision, or sudden stop — can cause the brain to shift and stretch briefly inside the skull. This leads to a temporary disruption in how brain cells communicate, rather than structural damage.

Several systems often contribute to concussion symptoms:

• The brain – responsible for thinking, memory, and processing speed.
• The vestibular system (inner ear) – which controls balance and spatial awareness.
• The visual system – coordinating eye movement and focus.
• The cervical spine (neck) – which plays a key role in head control and sensory input.

When these systems are out of sync, symptoms like dizziness, headaches, poor concentration, and unsteadiness can occur. Importantly, this does not mean the brain is damaged — it means it needs time, appropriate stimulation, and gradual loading to return to normal function. The brain is highly adaptable and responds very well to guided rehabilitation.

What Causes the Symptoms (Acute vs Ongoing)

Acute onset

Most concussions occur after a clear event, such as a fall and hitting the head on the ground, a sports collision or tackle, a car accident or whiplash-type injury, or a blow to the head from an object. Symptoms may appear immediately or develop over the following hours or days.

Ongoing or persistent symptoms

Some people experience symptoms lasting longer than expected. This doesn’t mean recovery has failed or that something serious is wrong. Often, there is no single ongoing cause; the nervous system remains sensitive to movement, light, or cognitive load, or neck stiffness and balance issues continue to drive symptoms. Prolonged rest alone has often delayed recovery.

Key messages:

• Concussion is very common.
• Scans such as CT or MRI are often normal.
• Symptoms usually develop from a build-up of smaller stresses, not ongoing damage.
• The nervous system is adaptable and responds well to the right rehabilitation approach.

Common Symptoms

Symptoms vary between individuals and can fluctuate day to day. Common experiences include:

• Headache or pressure in the head
• Dizziness or light-headedness
• Feeling foggy, slowed down, or not quite yourself
• Sensitivity to light or noise
• Blurred or double vision, eye strain
• Poor concentration or memory
• Fatigue, especially with mental tasks
• Neck pain or stiffness
• Feeling unsteady or off balance

Symptoms are often aggravated by screen time, busy environments, rapid head movements, physical exertion too early, stress, or poor sleep.

Common Diagnoses

You may hear different terms used alongside concussion. These labels describe symptom patterns rather than permanent injury:

• Concussion (mild traumatic brain injury): A temporary disruption in brain function following a knock or rapid movement.
• Post-concussion syndrome: Ongoing symptoms beyond the expected recovery period, often related to nervous system sensitivity.
• Cervicogenic headache: Headaches driven by neck stiffness or joint irritation after trauma.
• Vestibular dysfunction: Balance and dizziness symptoms linked to the inner ear–brain connection.
• Visual or oculomotor dysfunction: Difficulty with eye tracking or focus, commonly contributing to headaches and fatigue.

How Physiotherapy Can Help

Physiotherapy is an important part of concussion recovery, particularly when symptoms linger or interfere with daily life. Treatment begins with a comprehensive assessment, evaluating your neck, balance, eye movements, posture, exercise tolerance, and symptom response to physical and mental load.

You’ll receive a clear explanation of what’s driving your symptoms and realistic expectations for recovery. Many people improve over days to weeks, while more persistent symptoms may take several weeks to a few months, with steady progress when properly guided.

Treatment may include:

• Hands-on therapy for the neck and surrounding joints.
• Balance and vestibular rehabilitation.
• Visual and eye-movement exercises.
• Graded aerobic exercise to restore tolerance safely.
• Education and pacing strategies to build confidence.

At our physiotherapy practice in Pretoria, supporting patients from The Moot, Mayville, and surrounding areas, concussion care focuses on calm reassurance, evidence-informed rehabilitation, and a safe return to work, sport, and daily life.