Concussion Recovery in Calgary: What Actually Helps (and What Used to Be Standard Advice)

Colin Bouma, PT, FCAMPT
Jun 18
8 min read

The first week after a concussion is disorienting in a literal sense. Lights feel too bright. Reading a screen for ten minutes leaves you exhausted. You’re fine for an hour, then suddenly fogged. Walking through a busy store makes you feel like you’re moving through water. Sleep doesn’t fix it. Someone — maybe an ER doctor, maybe a coach, maybe a well-meaning family member — told you to rest in a dark room until you feel better.

That advice is now actively wrong. The 6th International Consensus Statement on Concussion in Sport (Amsterdam, 2023) reversed roughly two decades of "strict rest" guidance. The current best practice — backed by rigorous trials — is early, structured, sub-symptom-threshold activity, not extended cocooning.

At our south Calgary physiotherapy clinic on MacLeod Trail, concussion is one of the conditions where the gap between current evidence and the advice people receive is the largest. This post replaces our previous version with a 2026-current view: what the Amsterdam consensus actually says, what the rehab actually involves, and how to tell if you’re tracking toward recovery or toward persistent symptoms.

What a concussion actually is

A concussion is a mild traumatic brain injury — a transient disturbance of brain function caused by a direct blow to the head, neck, face, or body that transmits force to the brain. It is a functional injury, not a structural one: standard imaging (CT, MRI) looks normal. The mechanism affects brain chemistry, blood flow, autonomic regulation, and how different brain regions communicate.

You do not need to lose consciousness to have a concussion. Most people don’t. Symptoms can be immediate or take 24–48 hours to fully appear, and they typically cluster into a few patterns: headache and pressure, dizziness and balance issues, visual disturbance, cognitive fog, mood changes, sleep disruption, and exercise intolerance. Which cluster dominates determines what rehab focuses on.

The biggest update from the Amsterdam consensus: strict rest is out

For years, the standard advice was "physical and cognitive rest until symptoms resolve." Multiple randomized trials over the last decade have shown that strict, prolonged rest is at best ineffective and at worst counterproductive — it prolongs symptoms, deconditions the patient, and increases the risk of persistent problems and low mood.

The Amsterdam consensus now recommends a brief initial rest period of 24–48 hours, followed by a gradual return to light cognitive and physical activity at a level that does not significantly worsen symptoms. The principle is symptom-limited activity, not symptom-zero rest.

Early sub-symptom aerobic exercise speeds recovery

The strongest single intervention to come out of the last decade of concussion research is early targeted aerobic exercise. The 2021 randomized trial by Leddy and colleagues (Lancet Child & Adolescent Health) showed that sub-symptom-threshold aerobic exercise prescribed within 10 days of a sport-related concussion shortened median recovery from 19 days to 14 days — and reduced the risk of developing persistent post-concussion symptoms by roughly 48%.

The way we determine your safe exercise dose is with the Buffalo Concussion Treadmill Test (BCTT) — a standardized graded test that identifies your symptom threshold heart rate. You then exercise at 80–90% of that heart rate for short, daily sessions. Done right, this is one of the most effective things you can do for concussion recovery, and it’s the opposite of the dark-room approach.

Vestibular and cervical rehabilitation: where physio earns its keep

A lot of post-concussion symptoms aren’t really brain symptoms — they’re vestibular (inner ear / balance system), oculomotor (eye control), or cervical (neck) symptoms triggered by the same impact that caused the concussion. The original randomized trial by Schneider and colleagues at the University of Calgary — yes, here in Calgary — was the first to show that targeted cervicovestibular physiotherapy in athletes with persistent symptoms produced an almost four-fold increase in the rate of medical clearance to return to sport by 8 weeks.

The kinds of treatments that produce these results are not generic. They include gaze stabilization drills, habituation exercises for motion sensitivity, dynamic balance progressions, oculomotor training, and targeted manual therapy and exercise for the cervical spine — all calibrated to symptom thresholds. This is what skilled concussion physiotherapy actually looks like.

Why “one concussion protocol” doesn’t work — concussion subtypes

One of the practical contributions of the Amsterdam consensus is the recognition that concussions present with different dominant symptom clusters, and that effective rehab matches the cluster:

· Vestibular: dizziness, motion sensitivity, balance issues.

· Oculomotor / visual: eye strain, blurred vision, trouble tracking, reading intolerance.

· Cervicogenic: neck pain, headaches starting at the base of the skull, headaches with neck movement.

· Autonomic / exercise-intolerant: heart rate doesn’t regulate well, exertion brings symptoms back.

· Cognitive / fatigue: fog, slowed processing, mental endurance limits.

· Mood / anxiety: irritability, low mood, sleep disruption.

Most patients have two or three clusters in play. The assessment’s job is to identify which ones are driving your symptoms, so the plan addresses what’s actually going on instead of generic rest.

What evidence-based concussion physiotherapy actually involves

1. A thorough multidomain assessment

We screen for red flags first (the list below). Then we evaluate cervical spine, vestibular and oculomotor function, balance, and exercise tolerance. The point is to identify which symptom clusters are active and which are quiet — because that determines your plan.

2. Cervical spine treatment

Almost every concussion involves a whiplash-type mechanism. Cervical contributors to headache, dizziness, and visual symptoms are routinely missed. Manual therapy, mobility, and targeted neck and scapular exercise often produce rapid changes — and unlock progress in the rest of the plan.

3. Vestibular and oculomotor rehabilitation

Gaze stabilization, habituation exercises, balance progressions, and oculomotor work for tracking, convergence, and saccadic accuracy. Calibrated to your symptom threshold and progressed weekly. This is the active treatment for dizziness and motion intolerance.

4. Sub-symptom aerobic exercise via BCTT

We use the Buffalo Concussion Treadmill Test to identify your symptom-onset heart rate, then prescribe daily aerobic exercise at 80–90% of that rate. As your tolerance improves, the heart rate target rises. This is the closest thing concussion has to a medication that works.

5. Return-to-learn and return-to-sport progression

Both follow staged protocols that gradually re-introduce cognitive and physical load. We work with schools, coaches, and families to coordinate timing. Returning too early to either is a major contributor to setbacks; staying away too long is a major contributor to persistent symptoms. Pacing is the skill.

How long does concussion recovery take?

For most adolescents and adults, symptoms resolve within 2 to 4 weeks with appropriate management. Recent meta-analyses put the prevalence of persistent post-concussion symptoms at roughly 15–30% at 3 months, depending on the definition used. The biggest factors that push someone into the persistent group are: not getting an early structured plan, prolonged rest, untreated cervical or vestibular contributors, and high symptom burden in the first week.

If your symptoms are not on a clear downward trend by 2–4 weeks, that’s the point to escalate care — not to wait it out. Persistent post-concussion symptoms are treatable, but the longer the delay, the longer the recovery.

Red flags: when to go to the ER, not the clinic

Get immediate emergency assessment for any of these after a head injury:

· Loss of consciousness for more than 30 seconds

· Repeated vomiting

· Worsening headache that becomes severe

· Seizure

· Slurred speech, confusion, or inability to recognize people or places

· Numbness or weakness on one side of the body

· Unequal pupils or vision loss

· Clear fluid from the nose or ears

· Increasing drowsiness, or difficulty waking

Physiotherapy is for the recovery phase — once a serious brain injury has been ruled out medically. If any of the above are present, go to the ER first.

Frequently asked questions

Should I rest in a dark room after a concussion?

No — not beyond the first 24–48 hours. The Amsterdam consensus and multiple randomized trials show that prolonged strict rest extends symptoms, deconditions the brain and body, and increases the risk of persistent problems. Brief initial rest is fine; what comes next is gradual, symptom-limited return to light activity, including a structured aerobic exercise plan once you’re past the first 48 hours.

When can I drive after a concussion?

Generally, you should not drive while you have significant symptoms of slowed reaction time, visual disturbance, dizziness, or impaired concentration. There’s no single rule that fits every concussion — for most adults, this means avoiding driving for the first 24–72 hours minimum and waiting until you can complete usual cognitive tasks without symptom flares. A clinician familiar with concussion can give you specific guidance.

Is it safe to exercise with a concussion?

Yes — and it’s currently the strongest single intervention in the evidence. The catch is that exercise needs to be prescribed correctly, at a heart rate that doesn’t significantly worsen symptoms. That’s why the Buffalo Concussion Treadmill Test exists. Random exercise at the wrong intensity can set you back. Structured sub-symptom-threshold aerobic exercise speeds recovery.

How long do concussion symptoms last?

Most people fully recover within 2–4 weeks with appropriate management. Roughly 15–30% experience persistent post-concussion symptoms past 3 months. The strongest predictor of moving from one group to the other is whether you got an early, structured rehab plan or whether you were told to wait it out. The data favours acting early.

Can a concussion cause neck pain and dizziness even if my head feels fine?

Yes — and these are often the symptoms that linger when other concussion symptoms have resolved. The same impact that concusses the brain whips the cervical spine and disturbs the vestibular system. Targeted cervicovestibular physiotherapy is one of the most evidence-supported interventions for these post-concussion symptoms; the original trial demonstrating this was done at the University of Calgary.

When can I return to sport after a concussion?

Only after you have completed a staged return-to-sport progression with no symptom return at each stage, and you have been medically cleared. The Amsterdam consensus outlines six stages from symptom-limited activity through to full contact and competition; advancing too quickly is a leading cause of setback and a risk factor for further injury. A clinician trained in concussion rehab walks you through this stepwise.

Book a concussion assessment in south Calgary

We’re located at 8989 MacLeod Trail SW, serving Haysboro, Kingsland, Acadia, Fairview, and the broader south Calgary community.

Your first visit is 45–60 minutes. We screen for red flags, identify which symptom clusters are driving your presentation, perform vestibular and oculomotor testing and cervical assessment, and where appropriate run a Buffalo Concussion Treadmill Test to establish your exercise threshold. You walk out with a plan that includes daily activity targets, a sub-symptom aerobic prescription, and a path back to school, work, or sport.

If you’ve been told to wait it out or rest in a dark room — let’s have a more accurate conversation. The plan you actually need looks different from what was standard advice five years ago.

About the author

Colin Bouma, PT, FCAMPT holds Fellow status with the Canadian Academy of Manipulative Physiotherapy — an advanced post-graduate qualification in orthopaedic manual physiotherapy held by only a small fraction of Canadian physiotherapists. He focuses on chronic and complex musculoskeletal pain and concussion rehabilitation at our south Calgary clinic on MacLeod Trail.

*This article is for general educational purposes only. It is not medical advice, does not replace individualized assessment by a qualified healthcare professional, and does not create a physiotherapist–patient relationship. Always consult a regulated healthcare provider before starting a new exercise program or making changes to your care.