Concussion after a crash: key points.
- Most concussions resolve within 2 to 4 weeks with the right plan.
- Prolonged complete rest is no longer the standard recommendation.
- Concussion frequently coexists with whiplash. Treating one in isolation misses half the picture.
- Red flags mean the ER, not a physio clinic.
What a concussion is, in plain terms.
A concussion — clinically, a mild traumatic brain injury — is a transient neurological disturbance caused by force transmitted to the brain. The 2023 Amsterdam Concussion in Sport consensus statement is the most recent international synthesis. The diagnosis is clinical — symptoms, cognitive testing, and a focused exam — not imaging.
The mechanism does not have to involve a direct head strike. A whiplash mechanism alone can produce concussion symptoms in some patients. After a crash, both cervical and concussion components are common, often together.
Red flags — go to ER, not a clinic.
Any of these warrants the ER or 911 immediately:
- Worsening or unusually severe headache.
- Repeated vomiting.
- Increasing confusion, slurred speech, or memory loss that gets worse.
- Seizure activity.
- Weakness or numbness in one side of the body.
- Unequal pupils, double vision, or vision loss.
- Inability to wake or stay awake.
Lions Gate Hospital is the closest ER for the North Shore. The Canadian CT Head Rule is the standard tool for whether imaging is needed; the ER team will apply it.
Why graded sub-symptom-threshold activity is now standard.
The older "dark room for 2 weeks" approach has been replaced. Multiple clinical trials, summarised in the Amsterdam consensus, show that early structured activity below the symptom threshold improves recovery time compared with prolonged rest. Twenty-four to 48 hours of relative rest is reasonable; beyond that, the evidence supports gradual reintroduction of cognitive and physical activity.
Practically, this means short, frequent bouts of light cognitive and physical work — walking, reading, screen exposure — at a level that does not push symptoms past a tolerable threshold. The intensity climbs as the threshold rises.
Cervical and vestibular sub-types.
Two patterns are particularly common after a crash. A cervicogenic component presents with neck pain, restricted upper cervical motion, and headache that tracks with neck loading. A vestibular-ocular component presents with dizziness, motion sensitivity, fogginess in busy visual environments, and difficulty with scanning movements.
Both are screened on the first physiotherapy visit and both have specific rehab approaches — manual therapy, cervical proprioception, and graded cognitive loading for the cervical side; gaze-stability, habituation, and graded vestibular exercises for the vestibular side. Treating one without the other leaves recovery incomplete.
Returning to work, screen, and driving.
Return-to-activity is staged. A typical sequence: light cognitive activity at home; gradual screen reintroduction; short work blocks from home; partial in-office attendance; full duties. Driving is added when symptom load is low at normal traffic speeds and visual scanning is comfortable.
Your physiotherapist will tell you what criteria you need to clear at each stage, and your GP or family doctor handles any formal return-to-work paperwork.
Concussion and ICBC: common questions.
Do I have a concussion if I didn't hit my head?+
You can. A concussion is caused by a force transmitted to the brain, not specifically by a direct head strike. A whiplash mechanism alone can produce concussion symptoms in some cases. The clinical picture matters more than the hit.
When can I go back to work or school?+
Current guidance supports a gradual, sub-symptom-threshold return as soon as symptoms allow — often within days. Complete rest beyond 24 to 48 hours does not improve outcomes and can delay recovery. Your plan should be staged, not all-or-nothing.
When can I drive again?+
When your symptoms allow safe attention, reaction time, and visual scanning at normal traffic speeds, and you are confident in busy environments. There is no fixed timeline. Your clinician should give you criteria, not a date.
Do I need a CT scan?+
Most concussions do not require imaging. The Canadian CT Head Rule and similar tools guide when imaging is needed. Red flags — repeated vomiting, focal neurological signs, worsening confusion, seizures — change the answer. In those cases, you go to the ER, not a physiotherapy clinic.
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This page is for general information only and does not constitute medical or legal advice. ICBC coverage details, treatment allotments, and claim rules change — confirm the current terms with ICBC or a legal adviser before relying on them. Treatment suitability is determined case-by-case during clinical assessment. Physiotherapy at Medstar Sport Physio & Health is provided by physiotherapists registered with the College of Physical Therapists of British Columbia (CPTBC).