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Initial Consultation: $150

Advanced concussion diagnosis and rehabilitation processes.

Irwin Physiotherapy Concussion Care Program



So you have sustained a concussion – NOW WHAT?

Onset of Symptoms:

Symptoms of a concussion can take 48-72 hours to fully evolve after sustaining a concussion.  It is common to feel fine after the initial incident and then wake up the next morning with increased symptoms.

The most common symptoms are:

  1. Headaches

  2. Dizziness

  3. Nausea

  4. Difficulty concentrating

  5. Light or noise sensitivity

  6. Fatigue

Note: This is not an exhaustive list of symptoms but simply the most common ones. 

What should I do?

  1. Seek medical attention if you haven’t already done so

  2. Cognitive Rest Strategies (7-10 days post-concussion)

    • Rest/sleep as much as you feel you need to for the first 7-10 days post-concussion. Your brain is attempting to heal itself and will require more energy from the body leading to both physical and mental fatigue.

    • Low sugar/high protein diet

    • No caffeine (coffee, tea, energy drinks, sodas, etc...) after 4 pm. Caffeine disrupts your natural sleep patterns.

    • Avoid large crowds or noisy environments (grocery stores, large stores or restaurants). Initially, the exposure to crowded/multi-stimulus environments will increase symptoms of headaches, dizziness, nausea, fatigue and general disorientation

    • Decrease stimulus at home – avoid activities that bring on your symptoms but don’t isolate yourself to the “darkroom”

    • Avoid the use of computers, smartphones, tablets, and television. The lighting and screen oscillations on electronics can cause increased visual fatigue, headaches, dizziness and nausea.

    • Decrease the use of fluorescent or LED lighting in the house. Indirect lighting or natural lighting will be better tolerated

    • Wearing sunglasses in the house or when outside can help reduce eye fatigue

  3. Remove yourself from all sporting activities where there is potential for sustaining another concussion – this removal will continue until you are medically cleared by your family doctor

  4. Do not isolate yourself in your home. After a few days, start going for short walks outside. Choose a time of day that is not too busy on the sidewalk or roadway.  Keep the duration short initially – it is always easier to add time to your next walk

  5. Seek physiotherapy to begin your rehabilitation journey

How do I recover?

Irwin Physiotherapy has a very specialized concussion rehabilitation program that involves:

  1. Initial Physiotherapy Assessment – The initial assessment is structured to identify the specific impairments that are associated with your concussion. This involves a detailed:

  •  History of the injury and a discussion regarding the symptoms that you are experiencing

  • Physical examination that identifies any neck or upper back joint issues, visual or oculomotor (eye movement) issues, vestibular (balance/dizziness) issues or motion sensitivity issues

  • Education with regards to the assessment findings

  • ImPACT™  Neurocognitive Screen


The ImPACT Neurocognitive Screen is a computerized screening tool that is used to evaluate visual/verbal memory, visual-motor speed, reaction time and general symptoms. This is an effective tool used to monitor recovery during your rehabilitation and to establish your appropriateness for discharge and return to sport.

Additional details regarding the ImPACT™ Neurocognitive Screen can be found at

2. Academic Accommodations (School-Aged Patient) - Return to school is a very important part of both your recovery and your return to social normalcy. Academic Accommodations are established with your school prior to your return to allow you to return but not aggravate your symptoms. These may include wearing sunglasses or a hat in class, changing your seat/desk location in the class, limiting hours of attendance and implementing rest breaks as needed.

3. Individualized Concussion Rehabilitation Program – this is established based on the information obtained from the physical examination. Program components can involve:

  • Visual convergence training exercises

  • Visual accommodation exercises

  • Visual tracking exercises

  • Gaze fixation exercises

  • Motion desensitization exercises

  • Balance retraining exercises

  • Cervical Proprioception (neck positioning) exercises

  • Cardiovascular exercises

  • Progressive exertional training exercises

  • Cervical / Thoracic joint mobilizations to address any joint sprain issues

How long will it take to recover and get back to normal activities?

80% of concussions will recovery gradually over a 10-14 day period of time

The remaining 20% of concussions will require more specialized treatment.  The main factors that affect the recovery timeline are:

  1. Number of symptoms associated with the concussion

  2. Patient-reported severity of the symptoms/irritability of the symptoms during testing

  3. Time from initial concussion to seeking rehabilitation service

When can I return to my sport?

The return to sport process is a step-by-step process. 

The decision to begin the Return to Play (RTP) Protocol is made based on patient symptom reports, lack of symptom provocation during the physical testing, ImPACT™ Neurocognitive Screen scores within the “optimal” range and good tolerance to physical exertion activities/testing.

Medical clearance is required from a medical doctor to begin the RTP Protocol and to ultimately RTP without restrictions.  This process typically takes 2 weeks to complete.

An example of this RTP Protocol:

Reference: Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich (2008), Br J of Sports Med 2009; 43: i76-i84 doi:10.1136/bjsm.2009.058248


Additional Concussion Resources:

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