See a physiotherapist within 7 to 10 days of a concussion — sooner if symptoms are not improving after the first 48 hours of rest.
Direct answer: See a concussion-trained physiotherapist within 7 to 10 days of the injury. Book sooner if symptoms are getting worse, you’ve had a concussion before, or daily life is still disrupted after 48 to 72 hours of rest. Earlier assessment tends to shorten recovery and lower the risk of lingering symptoms.
Do I need to see a physio right after a concussion, or can I wait?
Give it the first 24 to 48 hours. That window is for rest, cognitive and physical, while the initial neurometabolic cascade settles. Getting assessed on day one rarely changes anything — and frankly, sitting through an exam when your symptoms are at their worst is miserable and not much use to anyone.
The window opens after that. The international concussion in sport consensus statements point the same direction: patients assessed and started on active rehab inside the first 7 to 10 days recover faster than the ones who rest passively and wait to be seen.
So: rest two days, then get assessed. Waiting weeks to see if it sorts itself out is the common mistake — by then the fastest-recovery window has already shut. If you’re at that point, our concussion management programme is where that assessment happens.
When a patient comes in later on, say after 2-3 weeks instead of the recommended 3-5 days, after sustaining a concussion, it is quite often that I see there are several things that could have been done sooner to assist them in recovering quicker. For example, someone might still be completely avoiding exercising because they were told to rest, or they could have significant neck and visual/vestibular symptoms that could have been assessed and treated much sooner.
What are the signs I should see a physio sooner, not later?
Any of these is a reason to book within a few days, not at the end of next week:
- Symptoms aren’t easing after 48 to 72 hours of rest. If the headache, brain fog, or dizziness isn’t trending down by day three, rest alone isn’t doing the job.
- You’ve had a previous concussion that you didn’t fully recover from. In my experience, when patients have sustained a second concussion within a short period of time, this is when we are typically the most concerned about a longer recovery. So with these cases in particular, it becomes even more important that we see them sooner rather than later to get them back on the right track as soon as possible.
- You’re dizzy or off-balance. Vestibular symptoms — spinning, motion sensitivity, feeling unsteady on your feet — are some of the clearest signs that targeted vestibular rehabilitation, not just rest, is what’s needed.
- You can’t read a screen, hold a conversation, or focus for more than a few minutes. That kind of cognitive-load symptom points to ongoing disruption that responds to active rehab.
- You’re an athlete with a return-to-play call pending. Contact and collision sport athletes need a proper sport concussion assessment behind the green light, not just a few symptom-free days.
- You’re a student, or your job runs on your head. A graduated return-to-learning plan and the right accommodations are part of what a concussion-trained physiotherapist sets up.
For a full picture of what symptoms to watch for, see our concussion symptoms guide for Vancouver patients.
Are there symptoms that mean I should go to the emergency room instead?
Yes. Some signs after a head impact aren’t a concussion at all — they’re a medical emergency, and they override everything else on this page.
Go to the nearest emergency department right away if you have:
- Repeated vomiting (more than one or two episodes)
- A headache that keeps getting worse, not better
- Seizures or convulsions
- Slurred speech, unequal pupils, or weakness in one arm or leg
- Increasing confusion or difficulty staying awake
- Clear fluid from the ears or nose
- Loss of consciousness lasting more than a minute
- Rapidly worsening neck pain after a fall or collision
These point to a more serious intracranial injury. Get them ruled out at the emergency department first — physiotherapy is the right next step once they have been.
What does a physiotherapy concussion assessment actually involve?
It’s not a chat about how you’re feeling. It’s a systematic check of the systems a concussion tends to knock out of sync.
Across both our Vancouver clinics we run the Complete Concussions Management Inc. (CCMI) protocol as part of our concussion management programme. A typical assessment covers:
- Cervical spine exam — the neck takes a hit in almost any head impact or whiplash, and neck-driven symptoms can mimic or stack on top of concussion symptoms
- Vestibulo-ocular motor screen (VOMS) — checks the inner-ear and visual-tracking systems; what shows up here steers the vestibular and oculomotor parts of the plan
- Buffalo Concussion Treadmill Test — finds the heart-rate threshold below which exercise doesn’t set symptoms off, which becomes the floor for graded aerobic rehab
- Symptom provocation testing — pins down which activities and positions trigger symptoms, so we can set your pacing for school, work, and sport
- Return-to-activity staging — the international graduated return-to-sport and return-to-learn protocols, mapped onto your case rather than a template
What you walk out with is a plan built around your injury, not a blanket order to rest.
Can I see a physio weeks or months after my concussion if I never got assessed?
Yes. Late is still worth it.
If you’re weeks or months out and still dealing with symptoms — a headache that won’t quit, ongoing dizziness, trouble concentrating, wrecked sleep, mood changes — those aren’t just “part of the concussion” you have to ride out. They’re treatable. Post-concussion syndrome answers to the same targeted assessment and rehab as an acute injury. It tends to take longer, because the systems involved have had more time to settle into bad patterns, but the path back is the same one.
To give you an example, a 50-year-old with a previously very active lifestyle who was struggling to get back to her previous activities including recreational soccer, came to see me after months of dealing with persistent concussion symptoms. Nobody had even given her basic education about what a concussion was and what systems were involved in causing her symptoms. After breaking it down for her on her initial visit, when she came back in for her next visit she told me that it was the most helpful thing anyone had done for her thus far and that she was already feeling significantly better, both physically and emotionally.
Frequently asked questions
How long after a concussion should I wait before seeing a physiotherapist?
Don’t let it run past 7 to 10 days from the injury. Rest the first 24 to 48 hours, then book. If symptoms are getting worse rather than just hanging around, book within a day or two. The evidence for a shorter recovery sits with early physiotherapy, not with waiting it out.
Do I need a doctor’s referral to see a physio for a concussion?
No. Physiotherapists in British Columbia are primary-contact practitioners, so you can book directly. The one exception: if you have any of the red-flag symptoms above, your first stop is a physician or the emergency department.
What if I had a concussion months ago and still have symptoms?
Book an assessment. Post-concussion syndrome — symptoms that drag on past four weeks — isn’t something to wait out. Whatever’s driving it (vestibular, oculomotor, cervical, or autonomic) can be identified and treated at any stage, and the sooner it’s assessed, the sooner it’s rehabilitated.
Can physiotherapy help concussions from car accidents or sports?
Yes — we see both regularly at South Granville and False Creek. For motor vehicle accidents, Envision direct-bills ICBC and no referral is needed. For sport concussions, we follow the international graduated return-to-play protocol and provide the formal clearance documentation many leagues and teams ask for.
Is it normal for a physio to assess the neck during a concussion assessment?
Yes, and it’s one of the more important parts. The neck is involved in most concussions, especially anything with a whiplash component, and neck dysfunction can throw off headache, dizziness, and visual symptoms that look almost identical to a concussion. Treating it alongside the neurological systems usually speeds things up.
About the author
Harry Toor is a registered physiotherapist and co-owner of Envision Physiotherapy in Vancouver. He spent three years as the therapist for the Canadian Men’s Ski Team and was part of the medical team for the 2006 and 2010 Winter Olympics. He is an instructor for Sport Physiotherapy Canada (including First-Responder for Sport) and the Canadian Red Cross, an Adjunct Professor in the Gross Anatomy Lab at UBC’s Physiotherapy Masters Program, and an IMS instructor for Foundations Health Education. His treatment combines manual therapy, IMS and exercise.
Book a concussion assessment at Envision Physiotherapy.
Both clinics — South Granville (604-737-7309) and False Creek / Olympic Village (604-876-2344) — hold same-week spots open for recent concussions. No referral needed. If you’re not sure whether to wait or book, get in touch and ask; that’s a conversation we have most days.
This article is written for educational purposes and does not replace individual medical advice. If you suspect a serious head injury, go to the nearest emergency department.