Concussion Management — North Vancouver

The old advice was 48–72 hours of complete rest, then gradual return. Current evidence supports starting sub-symptom aerobic activity as early as 24–48 hours post-injury, and beginning physiotherapy assessment within the first week if symptoms are not rapidly resolving. Early physiotherapy that stays below the symptom threshold does not prolong recovery — it accelerates it. Complete rest beyond 48 hours has been associated with slower recovery in multiple studies.

The "cocoon therapy" approach — complete rest until all symptoms resolve — was the standard recommendation prior to 2017. The Berlin consensus and subsequent research overturned it. For most people, prolonged rest leads to deconditioning, sleep disruption, anxiety, and a symptom flare when they try to return to activity. A graded, monitored return to activity and targeted treatment of the cervical, vestibular, and oculomotor sub-systems gets people back faster with a lower risk of prolonged symptoms.

Yes. Concussion following a motor-vehicle collision is covered under ICBC's pre-approved 25-session physiotherapy block. If your recovery requires more sessions, we submit clinical documentation to ICBC to justify the extension. We direct-bill ICBC directly — no upfront cost at the visit.

Yes. Youth concussion management follows the same principles as adult concussion, with additional attention to academic impact (we can provide a letter for the school supporting a modified workload), and a more conservative return-to-sport timeline since growing brains have a longer vulnerability window. A parent or guardian attends the first visit for patients under 16.

No. Post-concussion syndrome responds to physiotherapy even months or years after the injury. The cervical spine and vestibular components in particular can be directly treated regardless of how long they have been present. The exertion intolerance component responds to a graded aerobic training programme at any stage. What changes with a longer time course is the assessment — we need to rule out other causes of persistent symptoms and make sure the programme is calibrated to your current baseline.

Sport medicine physicians diagnose concussion, manage medication when relevant (sleep aids, anti-nausea), and provide the medical clearance that some leagues require before return-to-contact training. Physiotherapists deliver the hands-on treatment: cervical manual therapy, vestibular repositioning and rehabilitation, oculomotor exercises, and the graded return-to-sport protocol. The two roles are complementary. We can work alongside your sport med doctor or family physician, and we'll write a clear clinical summary at any stage if they need one.

Most concussions do not require imaging because concussion is a functional, not structural, injury — it doesn't show up on CT or standard MRI. The Canadian CT Head Rule guides the decision for CT: it's indicated for specific red flags (LOC over 30 seconds, GCS below 15, suspected skull fracture, age over 65, two or more vomiting episodes). If you have any of those features, go to Lions Gate Hospital emergency rather than physio first. For most sport and MVA concussions, imaging is not indicated and physiotherapy can begin without it.