Concussion: Why Baseline Testing, Early Identification, and Physical Therapy Matter
Lisa Brekke, PT, DPT
A concussion can look different from one person to the next. Some people experience headache and dizziness immediately, while others primarily notice difficulty concentrating, fatigue, visual sensitivity, balance problems, or feeling “off.” Because concussion is a functional injury rather than something that can be confirmed with a standard imaging study, recognizing changes from a person’s normal baseline and completing a thorough clinical assessment are essential.
The good news? We have moved well beyond the idea that the best treatment for concussion is to lie in a dark room until symptoms disappear. Current evidence supports early, individualized activity and targeted rehabilitation to help people recover and return to the activities that matter to them.
What Is Concussion?
Concussion, or mild traumatic brain injury (mTBI), occurs when an external force causes the brain to experience a rapid acceleration, deceleration, or rotational movement.
Common symptoms include:
Headache or pressure
Dizziness or imbalance
Nausea
Neck pain or stiffness
Sensitivity to light or sound
Visual symptoms
Difficulty concentrating or remembering
Fatigue
Sleep changes
Irritability or emotional changes
Reduced tolerance for exercise or busy environments
Importantly, no single test can diagnose concussion or determine recovery. Current consensus recommendations support a multimodal assessment that considers symptoms, neurological findings, balance, cervical function, vestibular and oculomotor function, cognition, and physical exertion.
Baseline Testing: Knowing What “Normal” Looks Like
Baseline testing is performed before an injury occurs and provides information about an individual's typical function. This can be particularly useful for athletes who participate in sports with a higher risk of concussion.
A useful baseline may include:
Concussion symptom inventory
Balance assessment
Cognitive screening
Vestibular and oculomotor measures
Reaction time or processing speed
Cervical assessment
Exercise tolerance or heart-rate response
Relevant medical and concussion history
Baseline testing should not be viewed as a pass/fail test or as a requirement for determining whether someone has a concussion. Computerized neurocognitive testing, in particular, should never be interpreted in isolation. The Amsterdam consensus emphasizes that these results should be considered alongside the broader clinical picture.
Instead, baseline testing provides another piece of information: How does this person's function compare with their own pre-injury status?
That information can be especially valuable when symptoms are subtle or when an athlete's post-injury performance is difficult to interpret.
Early Identification Matters
When a concussion is suspected, early recognition and appropriate removal from activities with a risk of additional injury are important.
A person does not need to “look concussed” to have a concussion. Some individuals remain able to talk, walk, or even continue participating while experiencing meaningful changes in their neurological function.
Early assessment helps establish:
What symptoms are present?
Which systems appear to be contributing to those symptoms?
What activities are currently tolerated?
What should be temporarily modified?
What can safely be started now?
The Amsterdam consensus recommends multimodal assessment and emphasizes removal from play when concussion is suspected. It also provides updated tools for acute and subacute assessment, including the SCAT6 and SCOAT6.
Rest Is Not the Same as Recovery
One of the biggest changes in concussion management has been our understanding of rest.
More rest is not necessarily better.
Current evidence does not support strict physical and cognitive rest until every symptom disappears. Instead, relative rest is recommended during the first 24–48 hours, followed by a gradual return to activity as tolerated. Light physical activity, such as walking, can generally begin during this early period when it does not significantly worsen symptoms.
For many patients, this means replacing:
“Don't do anything until you feel completely normal.”
with:
“Let's determine what your brain and body can tolerate today, and gradually build from there.”
That distinction is important.
Where Physical Therapy Fits In
Physical therapy can play an important role in concussion recovery because concussion frequently affects systems that physical therapists routinely assess and treat.
Depending on the individual's presentation, rehabilitation may address:
Vestibular function
Dizziness, motion sensitivity, visual motion intolerance, gaze instability, and balance deficits may respond to individualized vestibular rehabilitation.
Oculomotor and visual function
Some individuals develop difficulty with eye movements, visual tracking, focusing, or tolerating visually busy environments. Treatment can be directed toward the specific impairment rather than simply avoiding visual stimulation.
Cervical spine
Neck pain, restricted mobility, and cervicogenic headache can contribute to persistent symptoms following concussion.
Exercise tolerance
Exercise intolerance can occur following concussion and may reflect altered autonomic and physiological regulation. Subsymptom-threshold aerobic exercise can be prescribed and progressed based on the individual's response.
Balance and coordination
Static and dynamic balance, gait, dual-task performance, and sensory integration can all be affected and can be specifically assessed and treated.
Return to activity
A physical therapist can help determine appropriate activity levels and progress exercise while monitoring symptom response and functional performance.
The goal isn't simply to make a patient “symptom free.” It is to help them restore function and build tolerance for the demands of everyday life, school, work, exercise, and sport.
Why Early Physical Therapy Can Make a Difference
The current evidence supports early physical activity and aerobic exercise following concussion. The Amsterdam consensus specifically identifies aerobic exercise as an effective early intervention and recommends subsymptom-threshold aerobic exercise when appropriate.
For individuals with dizziness, balance problems, neck pain, or headaches, targeted cervicovestibular rehabilitation may also be appropriate. The consensus recommends cervicovestibular rehabilitation when dizziness, neck pain, and/or headaches persist beyond approximately 10 days.
This doesn't mean that everyone with a concussion needs physical therapy immediately, or that every concussion should be treated the same way.
It means that rehabilitation should be based on the individual's presentation rather than waiting for symptoms to become chronic before addressing identifiable impairments.
The Goal: Individualized Recovery
Concussion recovery is not a straight line.
One person may primarily need graded aerobic exercise. Another may need vestibular rehabilitation. Someone else may have significant cervical involvement, visual motion sensitivity, migraine-like headaches, or difficulty tolerating cognitive and physical demands.
A comprehensive approach asks:
What systems are affected?
What activities are limited?
What does this person need to return to?
What can we safely train today?
That is where baseline information, early identification, and skilled rehabilitation come together.
The Bottom Line
Concussion management has evolved.
Baseline testing can provide valuable information about an individual's normal function. Early identification allows appropriate assessment and protection from additional injury. And early, targeted rehabilitation can help patients safely rebuild physical, cognitive, and sensory tolerance.
Rather than waiting for someone to “just get better,” modern concussion care focuses on early assessment, appropriate activity, individualized rehabilitation, and a gradual return to the activities that matter most.
If you or your child has experienced a concussion and is struggling with dizziness, headaches, balance problems, visual symptoms, exercise intolerance, or difficulty returning to school, work, or sport, a comprehensive concussion evaluation can help identify which systems may be contributing to symptoms and guide an individualized recovery plan. Contact lisab@brekkerehabconsulting.com if you have any questions.
For mentees: Move beyond the checklist. Build your clinical reasoning. Get individualized mentorship to help you understand the “why” behind your concussion assessment and treatment.
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