Concussion Symptoms: A Vancouver Physiotherapist’s Guide to What’s Normal, What’s Not, and When to Get Help

by Admin Envision in Concussion & Vestibular

A concussion is a brain injury — and most people don’t realise that until the symptoms don’t go away on their own.

The majority of concussions resolve within two to four weeks. But about one in five people develop persistent symptoms that linger for months, and the difference between a clean recovery and post-concussion syndrome often comes down to one thing: how soon someone with the right training takes a careful look at the injury.

This guide walks through the symptoms we look for at Envision Physiotherapy in Vancouver — what’s expected, what’s a red flag, and what evidence-based concussion physiotherapy actually does to speed recovery.

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What is a concussion, exactly?

A concussion is a mild traumatic brain injury (mTBI) caused by a direct blow to the head, neck or body that transmits force to the brain. The brain shifts inside the skull, neurons stretch, and a temporary chemical-and-energy crisis follows that disrupts normal cell function for hours to days.

A few clinical points that surprise most patients:

  • You don\’t need to lose consciousness. Fewer than 10% of concussions involve loss of consciousness.
  • You don\’t need to hit your head. A whiplash mechanism (e.g. a rear-end car crash) is enough.
  • Imaging is usually normal. CT scans and MRIs are designed to rule out bleeding or skull fractures, not to detect concussion. A normal scan does not mean nothing happened.

The diagnosis is made clinically — by a healthcare practitioner trained in concussion who takes a history, observes how you move, and runs targeted tests for the visual, vestibular, cervical and autonomic systems. That’s the assessment we run at our two Vancouver clinics in South Granville and False Creek.

Common concussion symptoms — the four clusters

Most patients describe a “fog” — but when we screen carefully, concussion symptoms almost always fall into four overlapping clusters. Recovery depends on identifying which cluster (or clusters) is driving your case.

1. Physical / somatic

  • Headache — the most common single symptom (~85% of cases)
  • Dizziness or feeling unsteady on your feet
  • Nausea, sometimes with vomiting in the first 24 hours
  • Light sensitivity (photophobia) — bright screens, fluorescent lights
  • Noise sensitivity (phonophobia)
  • Blurred or double vision, difficulty focusing on a screen
  • Neck pain or stiffness — almost always present and almost always under-treated

2. Cognitive

  • “Brain fog” — difficulty thinking clearly
  • Difficulty concentrating at work or while reading
  • Slowed reaction time
  • Short-term memory lapses — especially around the time of injury
  • Difficulty multitasking

3. Emotional

  • Irritability or short temper
  • Anxiety, sometimes for the first time in your life
  • Low mood or sadness
  • Feeling overwhelmed by ordinary stimulation

4. Sleep

  • Insomnia or trouble falling asleep
  • Sleeping too much in the first week, then trouble staying asleep
  • Waking unrefreshed

If you’re checking off symptoms across two or more clusters, you should be assessed.

Red-flag symptoms — go to an emergency department, not a clinic

A concussion is a mild brain injury. But occasionally a head impact causes a more serious injury that needs imaging within hours. Go to the nearest emergency department immediately if you experience any of:

  • Repeated vomiting (more than 1–2 episodes)
  • Worsening headache that won\’t respond to anything
  • Seizures or convulsions
  • Slurred speech, weakness in an arm or leg, asymmetric pupils
  • Increasing drowsiness or difficulty waking
  • Clear fluid or bleeding from the ears or nose
  • Loss of consciousness lasting more than a minute
  • Worsening confusion or behavioural change
  • Worsening neck pain after a fall or motor-vehicle crash (rule out cervical spine injury)

For everything else — the persistent fog, the dizziness that won\’t quit, the inability to read your screen for more than 20 minutes — concussion physiotherapy is exactly the right next step.

How long do concussion symptoms last?

The honest answer: it depends on how early you start the right rehab.

The current consensus from the Berlin and Amsterdam Concussion in Sport statements is:

  • 80–85% of adults recover within 14 days
  • Adolescents typically recover within 4 weeks
  • 15–20% of patients develop post-concussion syndrome — symptoms that persist beyond 4 weeks (10 days in the original definitions)

The single most modifiable predictor of recovery time is how quickly you\’re assessed by someone trained in concussion management. Multiple studies now show that earlier physiotherapy intervention — within the first 7 to 10 days — measurably shortens recovery and reduces the risk of chronic symptoms.

That\’s why we keep same-week appointments open at both Vancouver clinics for fresh injuries.

What is post-concussion syndrome?

When concussion symptoms persist beyond 4 weeks, the diagnosis is post-concussion syndrome (PCS). PCS is not a separate injury — it’s an indication that one or more of the underlying systems hasn’t recovered on its own.

In our Vancouver clinic the dominant drivers of PCS are usually:

1. Vestibular dysfunction — the inner-ear and brainstem pathways that handle balance and gaze stability are under-firing. Dizziness, motion sensitivity and brain fog persist. The fix is targeted vestibular rehabilitation — not rest.

2. Visual / oculomotor dysfunction — eye-teaming, smooth pursuits and saccades aren’t coordinating, which feels like “I can’t read screens any more.”

3. Cervicogenic symptoms — the upper neck took a hit too. Cervical-spine treatment alone resolves a meaningful share of “concussion” headaches.

4. Autonomic / exercise intolerance — heart-rate response to exertion is dysregulated; even a walk provokes symptoms. Sub-symptom-threshold cardio is the evidence-based fix.

5. Sleep, mood and metabolic factors — addressed alongside the above.

A good concussion assessment isolates which of these systems are involved in your case, then prescribes a specific rehab program. There is no single “concussion treatment” — there\’s a portfolio, and the rehab plan is built around what your assessment shows.

How a Vancouver concussion physiotherapist treats symptoms

At our Vancouver concussion clinic, we run the Complete Concussions Management Inc. (CCMI) protocol. The full pathway includes:

  • Cervical examination and manual therapy for the upper neck and any whiplash component
  • Vestibular ocular motor screen (VOMS) to measure visual and inner-ear dysfunction
  • Buffalo Concussion Treadmill Test to find your safe sub-symptom-threshold heart-rate ceiling
  • Gaze stabilisation, habituation and balance exercises if vestibular symptoms are present
  • Saccade and convergence retraining if oculomotor symptoms are present
  • Graded aerobic exercise prescription at your sub-symptom threshold (this is now a top-tier evidence-based intervention)
  • Return-to-school, return-to-work, return-to-sport progressions that follow the international stage-by-stage protocols
  • Education — what to expect, what’s safe, what’s not, and how to pace your week

For athletes, our Sport Concussion Baseline Testing program lets us compare post-injury performance against your own pre-season baseline rather than population averages — a meaningful improvement in return-to-play decisions.

The team running these assessments at Envision:

All three are registered with the College of Physical Therapists of British Columbia.

When should you book an assessment?

The short answer: as soon as possible.

You should book within 7 to 10 days of injury if any of these are true:

  • Your symptoms aren’t improving day over day after the first 48–72 hours
  • You can’t return to your normal screen time, reading load or workout schedule
  • Dizziness, motion sensitivity or visual fatigue is interfering with daily activities
  • You’ve had a previous concussion (your risk of prolonged recovery is higher)
  • You’re an athlete with a season or a return-to-play decision pending

You can book online through our Jane App or contact us directly — we have appointments at both Vancouver clinics most weeks within a few days of inquiry.

Locations:

  • South Granville — 3077 Granville Street, Vancouver, BC V6H 3J9 · (604) 737-7309
  • False Creek / Olympic Village — 672 Leg-In-Boot Square, Vancouver, BC V5Z 4B4 · (604) 876-2344

No referral required. Direct billing to most extended health insurance plans, ICBC and WorkSafeBC.

Frequently asked questions

Can I have a concussion without hitting my head?

Yes. Roughly 30% of concussions are caused by whiplash-style mechanisms with no direct head impact — common in motor vehicle accidents, sports collisions and slips/falls.

Should I rest in a dark room?

Only briefly. The evidence is now clear that prolonged “cocoon” rest in a dark room beyond 24–48 hours slows recovery and is associated with worse outcomes than active, sub-symptom-threshold rehab. After the initial rest period, gradual reintroduction of activity at a level that does not provoke symptoms is the standard of care.

Is post-concussion syndrome permanent?

No — most cases of PCS respond well to a targeted assessment and appropriate rehabilitation. The longer symptoms have persisted, the longer recovery typically takes, but improvement remains achievable in the vast majority of cases we see. If you\’re months out from injury and still symptomatic, it is worth being assessed.

Can children and teenagers get concussion physiotherapy?

Yes. Adolescents recover more slowly than adults on average and benefit from concussion physiotherapy, often with school-accommodation letters built into the rehab plan. Our team includes physiotherapists with experience in the adolescent population.

Do you treat concussions from car accidents (ICBC)?

Yes. We accept and direct-bill ICBC concussion claims at both Vancouver clinics. If you\’ve been in a motor vehicle accident, your ICBC claim covers physiotherapy without requiring a referral — and concussion + cervical spine physiotherapy is one of the highest-yield interventions in the first 90 days.

How does concussion physiotherapy differ from seeing my GP?

GPs are essential for the medical workup — ruling out bleeding, prescribing medication, signing return-to-work notes. Concussion physiotherapy is the rehab side: assessing and retraining the specific systems (vestibular, oculomotor, cervical, autonomic) that are driving your symptoms. Most patients with persistent symptoms benefit from both.

Ready to get assessed?

If you\’ve had a concussion in the last week — or if symptoms from an older injury haven\’t fully resolved — the most important step is to be seen by a clinician trained specifically in concussion management.

Book a concussion assessment at Envision Physiotherapy →

This article is for educational purposes only and is not a substitute for individual medical advice. If you suspect a serious head injury, attend the nearest emergency department.

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