Concussion Is Not Just Being Dizzy

Physical TherapyFor Athletes
Written By Derek Hackett

Kristen Johnston DPT, Physical Therapist, Prairie Grit Therapy

Dizziness is one symptom of a concussion. It is not the injury.

A concussion changes how the brain uses energy. That shows up in vision, balance, sleep, concentration, mood, and how the body tolerates exertion. An athlete can pass a sideline check, feel mostly fine on the drive home, and still be unable to read a page of homework three days later.

That gap is where most people get concussion wrong. This article covers what the injury looks like and what to do in the first 48 hours.

What it actually looks like

Symptoms fall into groups. Most athletes get some from several groups, not all from one.  Concussions are like snowflakes, no two look alike.

Physical

Headache, neck pain, pressure in the head, nausea, sensitivity to light, sensitivity to noise, fatigue that sleep does not fix.

Vision and balance

Trouble tracking a moving ball. Words swimming on a page. Losing your place mid-sentence. Feeling unsteady turning corners, walking down a grocery aisle, or scrolling a phone.

Thinking

Slowed processing. Losing the thread in conversation. Rereading the same paragraph. Struggling to hold instructions. Athletes often describe this as fog, and it is the symptom that wrecks school performance.

Sleep and mood

Sleeping far more or far less than usual. Irritability. Anxiety. A short fuse that is out of character. Families notice this one before the athlete does.

Exertion

Symptoms that appear when the heart rate climbs. The athlete feels fine at rest, starts running, and the headache arrives at minute four. This is exercise intolerance, and it is measurable.

An athlete who says "I'm fine" at rest may still fail at a heart rate of 140.

The rest advice you remember is out of date

For years the instruction was a dark room and no activity until symptoms cleared. That is no longer the recommendation.

The 2023 international consensus statement on concussion in sport, published in the British Journal of Sports Medicine, moved away from strict rest. Current guidance supports light activity such as walking within the first 24 to 48 hours, as long as it does not increase symptoms more than mildly.

The reason matters. Extended inactivity has its own costs: deconditioning, isolation, missed school, low mood. Controlled activity is now part of treatment rather than something to avoid.

What to do in the first 48 hours

Five things, in order.

  • Remove the athlete from play. Same day return is not appropriate after a suspected concussion and may result in up to 8x delayed recovery period

  • Get evaluated by a qualified health care provider

  • Do not let the athlete drive until a provider clears it

  • Tell the school. Teachers cannot accommodate what they do not know about

  • Allow light walking if it does not noticeably worsen symptoms

Write down what you see over the first two days. Symptom patterns are hard to remember later and useful to the provider.

Get emergency care for these

Go to the emergency room or call 911 if an athlete has:

  • A headache that keeps getting worse

  • Repeated vomiting

  • A seizure or convulsion

  • Slurred speech, weakness, numbness, or decreased coordination

  • One pupil larger than the other

  • Increasing confusion, agitation, or unusual behavior

  • Drowsiness, or cannot be woken up

  • Loss of consciousness.

These are danger signs of a more serious brain injury. They are rare. Treat them as an emergency anyway.

Next

Part 2: Back to Sport, School, and Life

The second article covers what physical therapy actually treats after a concussion, why returning to school comes before returning to play, and the six-step return to play progression.

Derek Hackett