Expert Management of Post Concussion Syndrome in Melbourne | Keilor Road Physiotherapy
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on June 19, 2025
Expert treatment for post concussion syndrome at Keilor Road Physiotherapy
Why choose Keilor Road Physiotherapy for concussion rehabilitation?
When to seek professional help for post concussion syndrome?
Concussions can occur unexpectedly, whether from sports, accidents, or falls, leaving individuals with ongoing symptoms that can significantly impact their daily lives. Post Concussion Syndrome (PCS) is a condition that arises when concussion symptoms persist beyond the expected recovery period, often lasting for weeks or months and is commonly linked to mild traumatic brain injury (mTBI). Terms like 'head injury,' 'traumatic brain injury,' and 'concussion' often overlap, yet they describe different aspects of head trauma.
If you’re experiencing symptoms such as dizziness, headaches, or cognitive difficulties after a concussion, seeking specialised concussion management is crucial. Our team of physiotherapists in Melbourne is dedicated to providing individually tailored care that targets the root causes of PCS and helps you recover as effectively as possible.
What is post concussion syndrome?
PCS can linger after any head trauma, whether it results in visible injuries or not. It’s critical to distinguish between the general terms:
Head injury: Can involve the scalp, skull, or brain, including contusions or fractures.
Traumatic brain injury (TBI): Caused by an external force, a TBI might not always present visible head injuries but can still result in concussion symptoms, often from falls, car accidents, sports, or physical assaults.
Concussion: This is a subset of TBI characterised by symptoms that might not be immediately apparent post-injury and can develop or persist over time.
Historically, these conditions have faced significant stigma, with symptoms frequently dismissed as malingering or misattributed purely to psychological factors. However, PCS is increasingly understood as a complex interplay between neurological irritation and physical trauma, often involving neck injuries due to the biomechanics of head impacts.
Symptoms of Post Concussion Syndrome:
Symptoms of post concussion syndrome can include:
Persistent headaches or migraines
Dizziness and balance problems
Fatigue and sleep disturbances
Memory problems and difficulty concentrating
Sensitivity to light or noise
Anxiety or irritability
Blurred vision
For many, these symptoms disrupt daily activities, from work to social events, making early intervention essential.
Causes of post concussion syndrome
Post Concussion Syndrome (PCS) typically develops following a concussion, which is a mild form of TBI. While the concussion itself is generally considered a mild injury, the lingering symptoms of PCS can have a significant impact on an individual's quality of life. Understanding the causes of PCS requires delving into the pathophysiology of concussions and how they affect brain function.
1. Impact-Related Brain Injury:
A concussion occurs when the brain experiences a sudden impact or acceleration-deceleration force, causing it to move rapidly within the skull. This can happen during activities like sports, accidents, falls, or even motor vehicle collisions. The brain's sudden movement within the skull results in shearing forces on brain cells, disrupting normal neuronal function and causing damage to the delicate tissue.
The brain's response to concussion is complex and involves multiple biochemical and physiological processes. The immediate effects of a concussion include:
Axonal Shearing: The force of impact causes stretching or tearing of axons (the long projections of nerve cells). This results in the disruption of electrical signals and communication between neurons, which can impair brain function.
Neurotransmitter Imbalance: Concussions lead to an imbalance in neurotransmitters such as glutamate and gamma-aminobutyric acid (GABA). Excessive glutamate release after injury increases excitability in the brain, contributing to symptoms such as headaches, confusion, and memory difficulties.
Metabolic Disturbance: Concussion also leads to disruptions in the brain’s energy metabolism. The brain may become more vulnerable to oxygen deprivation due to a metabolic crisis, making it harder to repair neuronal damage. This metabolic disturbance can impair cognitive function, leading to problems with concentration, memory, and mental clarity that are common in PCS.
Inflammation and Immune Response: Following a concussion, inflammation can occur within the brain. This inflammation can persist long after the injury, further disrupting brain function and contributing to the ongoing symptoms of PCS.
2. Repetitive Concussions and Cumulative Damage:
The risk of developing PCS increases with the number of concussions a person sustains. Repetitive concussions can cause cumulative damage to brain cells, leading to neurodegeneration over time. Each subsequent concussion has the potential to cause more severe neuronal damage, leading to longer recovery periods and an increased likelihood of chronic symptoms.
Additionally, multiple concussions can lead to a condition known as Second Impact Syndrome (SIS), which occurs when a person sustains a second concussion before the brain has fully healed from the first one. This condition can cause rapid and severe brain swelling, potentially leading to permanent damage or death. Though rare, SIS can compound the severity of PCS symptoms.
3. Vestibular System Dysfunction:
A common cause of symptoms in PCS is dysfunction of the vestibular system, which is responsible for maintaining balance and spatial orientation. Concussions can disrupt the vestibular system, leading to dizziness, vertigo, and balance problems. This disruption occurs because the inner ear structures, particularly the semicircular canals and otolith organs, are connected to the brainstem and cerebellum, which play vital roles in processing spatial information. A concussion can impair these connections, leading to the characteristic dizziness and balance problems associated with PCS.
4. Neck and Spine Injury:
Neck strain and cervical spine injuries are commonly associated with concussions, as the whiplash effect from the impact can cause cervical spine misalignment. The cervical spine (neck region) is closely linked to the brain through the spinal cord and nervous system. When the neck is injured, it can aggravate concussion symptoms by adding strain to the brain's communication pathways. This can lead to tension headaches, dizziness, and neck pain, all of which can worsen PCS symptoms.
5. Psychological and Emotional Factors:
Post concussion syndrome is not solely a physical condition; it also has a psychological and emotional component. Many individuals with PCS experience symptoms such as anxiety, irritability, and depression. This is partly because of the brain’s emotional regulation centres being affected by the concussion. The limbic system, which governs emotions, is vulnerable to injury from concussions. This emotional response can be compounded by the frustration of dealing with persistent symptoms, leading to a vicious cycle that exacerbates PCS.
6. Pre-Existing Vulnerabilities:
Certain pre-existing conditions or factors can increase the risk of developing PCS after a concussion. These may include:
Prior history of concussion: A person who has experienced previous concussions may have a higher risk of developing PCS after subsequent head injuries.
Genetic predispositions: Some individuals may have a genetic vulnerability that makes their brain more susceptible to long-term effects after a concussion.
Age and gender: Younger individuals and females have been shown to have a higher incidence of PCS following a concussion, though the reasons for this remain under study.
Specialist concussion rehab.
Diagnosis of post concussion syndrome
Diagnosing Post Concussion Syndrome (PCS) can be challenging because there is no single definitive test for the condition. The diagnosis is typically based on a thorough clinical evaluation that takes into account a patient’s symptoms, medical history, and the timing of their concussion. While imaging tests such as CT scans or MRIs may be used to rule out more serious brain injuries or structural damage, PCS is a functional disorder, which means it often doesn’t show up on standard imaging.
1. Clinical Evaluation:
The first step in diagnosing PCS is a comprehensive clinical evaluation. This involves taking a detailed medical history and conducting a physical examination, including assessing the neurological and cognitive functions. The evaluation will focus on:
Symptoms: The physiotherapist or healthcare provider will ask about the specific symptoms the patient is experiencing (headaches, dizziness, memory problems, etc.) and when they started in relation to the concussion.
Duration of Symptoms: PCS symptoms typically begin within a week after a concussion and last for more than a few weeks, often persisting for months. The persistence of symptoms after a concussion helps differentiate PCS from more typical recovery processes.
Cognitive and Emotional Changes: Patients are often asked about any difficulties with memory, concentration, or mood, as these are common in PCS.
History of Previous Concussions: If a patient has a history of multiple concussions, this can increase the likelihood of developing PCS. Repeated concussions can have a cumulative effect, increasing the risk of long-term symptoms.
2. Diagnostic Criteria:
The diagnostic criteria for PCS are generally based on symptom persistence after a concussion and the exclusion of other possible conditions. While the diagnostic criteria can vary slightly depending on the clinical guidelines followed, the most widely accepted criteria include:
Symptoms lasting more than 3 months: According to the International Classification of Diseases, 10th edition (ICD-10), a diagnosis of PCS is typically considered when symptoms persist for more than three months following the initial head injury. In some cases, symptoms may persist for up to a year or more, though this is less common.
At least three symptoms from the following categories:
Physical Symptoms:
Headaches (commonly tension-type or migraine)
Dizziness or vertigo
Fatigue
Sensitivity to light or noise
Cognitive Symptoms:
Memory difficulties
Impaired concentration
Mental fog or difficulty thinking clearly
Emotional Symptoms:
Irritability
Anxiety
Depression
Sleep disturbances: Difficulty falling asleep or staying asleep, or excessive sleepiness during the day.
PCS can be diagnosed when at least three of these symptoms are present and have lasted for a prolonged period (typically 3 months or more).
3. Exclusion of Other Conditions:
Since many of the symptoms of PCS overlap with other conditions (e.g., anxiety, depression, vestibular disorders, cervical spine issues), it’s important to rule out other potential causes of the symptoms. A differential diagnosis may involve:
Neuroimaging: While standard CT scans and MRIs are generally unremarkable in PCS, they are still important for ruling out other causes such as bleeding, structural damage, or brain tumours.
Vestibular Testing: Dizziness and balance problems are common symptoms of PCS, so a vestibular evaluation may be done to check for inner ear or balance disorders that might be contributing to these symptoms.
Neuropsychological Testing: In some cases, neuropsychological testing is performed to assess cognitive function, particularly memory, attention, and executive function. These tests can help identify cognitive deficits that may not be immediately obvious through a standard clinical exam.
Blood Tests: Blood tests may be used to rule out metabolic or endocrine disorders, which can sometimes mimic the symptoms of PCS.
4. Symptom Scales and Questionnaires:
Several standardised questionnaires and symptom scales are used to assess the severity and progression of PCS symptoms:
Post-Concussion Symptom Scale (PCSS): This is one of the most commonly used tools in assessing concussion symptoms. It includes a list of symptoms that the patient rates on a scale from 0 (none) to 6 (severe). The total score helps to determine the severity of PCS.
Rivermead Post Concussion Symptoms Questionnaire (RPQ): The RPQ is another widely used tool to assess concussion-related symptoms and monitor recovery over time. It is a self-reported questionnaire that evaluates 16 symptoms commonly associated with PCS.
Balance and Coordination Tests: Tests such as the Berg Balance Scale or the Sensory Organisation Test (SOT) are sometimes used to assess balance and vestibular function, which can be disrupted in PCS.
5. Role of Imaging:
Although there is no specific imaging test for PCS, advanced imaging techniques, such as functional MRI (fMRI) or positron emission tomography (PET), have been explored in research settings. These tools can provide more detailed information about how the brain is functioning after a concussion, but they are not typically used in routine clinical practice for diagnosing PCS.
6. Comprehensive Functional Assessment:
At Keilor Road Physiotherapy, we use a comprehensive functional assessment to evaluate the impact of PCS on a patient’s daily activities and overall function. This may include:
Strength and Conditioning Assessments: Using our AxIT Performance System and ForceDecks, we assess the patient’s physical strength and balance. This helps identify any areas of weakness or imbalance that may be contributing to their symptoms.
Vestibular Rehabilitation Assessment: Our physiotherapists conduct specialised vestibular tests to assess the function of the inner ear and balance system, which are often impacted by concussion.
Expert concussion treatment at Keilor Road Physiotherapy
At Keilor Road Physiotherapy, we consider PCS not just in the context of brain injury but as a combination of brain injury and potential cervical spine damage, with every concussion being unique. This approach stems from observations that:
Concussive forces often exceed the thresholds that can cause neck injuries, suggesting that even mild concussions likely involve significant neck strain.
The presence of headaches in PCS might not correlate directly with the severity of the TBI, hinting at alternative sources like neck issues.
Symptoms of cervicogenic headaches and whiplash mirror those of PCS, indicating that neck complications could independently produce similar symptoms.
Our expert physiotherapists in Melbourne create personalised rehabilitation plans to manage your PCS symptoms effectively. Here’s how we approach treatment:
1. Education:
Informing patients and making sure they understand the nature of their condition and the expected course of recovery.
2. Vestibular Rehabilitation Therapy (VRT):
One of the key treatments for post concussion syndrome is vestibular rehabilitation, which addresses dizziness, vertigo, and balance problems. VRT involves exercises designed to improve balance and visual stability, reducing symptoms related to dizziness and vertigo.
3. Neck and Spine Rehabilitation:
In many cases, PCS symptoms are aggravated by neck strain or misalignment. Neck pain and tension are common after a concussion, contributing to headaches and dizziness. Our physiotherapists work to alleviate these issues through targeted manual therapy, postural corrections, and strengthening exercises designed to restore proper alignment and function.
4. Manual Therapy and Soft Tissue Mobilisation:
Manual therapy techniques help alleviate pain, improve mobility, and promote relaxation in the neck and upper back. These techniques also reduce tension that may contribute to headaches or dizziness.
5. Guided Physical Activity:
Implementing a graded exercise program tailored to the individual’s symptoms and tolerance levels, which is crucial for recovery. Physical activity is introduced gradually to avoid exacerbation of symptoms while promoting physical and neurological recovery.
6. Cognitive Rehabilitation:
In some cases, patients experience cognitive difficulties after a concussion. Our team can guide you through exercises designed to improve memory, attention, and concentration. We work with each patient to design cognitive rehabilitation strategies that can be done at home or during sessions. We also refer patients to appropriate neuropsychological support if needed to address the cognitive and emotional challenges associated with PCS.
Our treatment approach is collaborative, involving regular monitoring and adjustments based on the patient's progress and feedback. We recognize that PCS can be a dynamically changing condition, and flexibility in the treatment plan is essential to accommodate the varying pace of recovery among individuals.
Expert concussion treatment Melbourne.
Why choose Keilor Road Physiotherapy for expert concussion management?
Keilor Road Physiotherapy don't just manage symptoms—we strive to identify and treat the root causes of PCS. Our specialised use of the Watson Headache® Approach allows us to effectively decrease neurological irritations in the neck, enhancing our capability to manage and alleviate the complex symptoms associated with PCS.
We understand the profound impact that persistent post-concussion symptoms can have on an individual's life. Therefore, we are committed to providing a comprehensive treatment plan that addresses both the neurological and musculoskeletal components of PCS. If you're experiencing ongoing symptoms following a concussion, let Keilor Road Physiotherapy help you navigate your recovery with expertise and compassionate care.
Prevention and long term management of concussion
Does wearing headgear reduce the risk of concussion?
A comprehensive systematic review and meta-analysis published in Sports Health analysed data from 6,311 soccer and rugby players, encompassing over 173,000 exposure hours. The study found no significant reduction in concussion rates among players wearing headgear compared to those not wearing it, with a risk ratio of 1.03 (95% CI: 0.82–1.30) (Attar et al., 2024).
Effective Concussion Prevention Strategies
Given the limited evidence supporting the effectiveness of headgear in preventing concussions, other strategies have been identified as more effective in reducing SRC risk:
Neuromuscular Training Programs: Implementing neuromuscular training warm-up programs in rugby has been associated with a 32%–60% lower concussion rate (Eliason et al., 2023).
Policy and Rule Modifications: Disallowing bodychecking in child and adolescent ice hockey has been associated with a 58% lower concussion rate compared to leagues that permit bodychecking (Eliason et al., 2023).
Limiting Contact Practice: Strategies limiting contact practice in American football are associated with a 64% lower practice-related concussion rate (Eliason et al., 2023). Promoting safe sporting practices and educating athletes about proper technique is vital in concussion prevention
Concussion Education: Educating athletes, coaches, and parents about concussion signs, symptoms, and proper techniques can lead to early identification and management, reducing the risk of long-term consequences.
Long Term Management Strategies for Post Concussion Syndrome
Early Intervention and Symptom Management: Early treatment is critical for managing PCS. Vestibular rehabilitation can help with balance and dizziness, while cognitive rehabilitation focuses on improving memory and concentration. Managing sleep disturbances and using appropriate pain management strategies (e.g., for headaches) can significantly ease symptoms.
Physiotherapy for Neck and Spine Rehabilitation: Neck pain and muscle tension often accompany PCS. Manual therapy and neck strengthening exercises help restore alignment and reduce pain, improving both physical function and comfort.
Gradual Return to Physical Activity: Reintroducing physical activity should be gradual. Start with low-intensity exercises, such as walking or swimming, and monitor symptoms. Gradually increase intensity as tolerated to avoid triggering symptoms.
Psychological Support and Emotional Well-being: Many individuals with PCS experience emotional difficulties, including anxiety and depression. Counselling, particularly cognitive-behavioural therapy (CBT), and stress management techniques such as relaxation exercises can help manage these symptoms.
Ongoing Monitoring and Adjustments to Treatment: PCS requires regular follow-ups to monitor symptoms and adjust treatment plans accordingly. Progress should be tracked to ensure that the recovery process is on track and effective.
Long-Term Cognitive Rehabilitation: For persistent cognitive issues, memory exercises and cognitive strategies can help improve mental function. Memory aids and other tools can assist in managing daily tasks and improving cognitive performance.
Lifestyle and Nutritional Support: A healthy diet, rich in omega-3 fatty acids and antioxidants, supports brain health. Staying hydrated and maintaining a regular physical activity routine also aid in long-term recovery and brain function.
When to seek help for post concussion syndrome?
PCS is diagnosed when symptoms persist beyond the typical recovery period, usually 7–10 days after a concussion. Research and guidelines suggest seeking help in the following circumstances:
1. Persistent Symptoms Beyond Three Weeks
According to the ICD-10, symptoms lasting longer than three months after a concussion suggest PCS. If symptoms like headaches or dizziness persist beyond the usual recovery window, it’s important to consult a healthcare provider for proper diagnosis and management.
2. Cognitive and Emotional Symptoms
PCS often involves cognitive issues (memory, attention) and emotional symptoms (anxiety, irritability). Giza and Hovda (2014) found that these disturbances can last long after the physical symptoms of concussion resolve. If these symptoms significantly impact daily activities, it’s essential to seek professional support, such as cognitive rehabilitation or psychological counselling.
3. Increased Risk of Complications
Those with a history of multiple concussions are at a higher risk of prolonged PCS. Repeated head injuries can lead to more severe symptoms (McCrory et al., 2017). If a second concussion occurs before full recovery from the first, immediate medical evaluation is needed to prevent Second Impact Syndrome (SIS).
4. Worsening or Unmanageable Symptoms
If symptoms like headaches or dizziness worsen over time, it’s crucial to seek help. The American Academy of Neurology guidelines stress that worsening symptoms may indicate complications, requiring more targeted interventions or adjustments to treatment plans (Giza et al, 2013).
5. Difficulty with Activities of Daily Living
PCS can interfere with work, school, or daily life. The US National Institute of Neurological Disorders and Stroke highlights that when PCS symptoms affect social or professional responsibilities, seeking help is important for effective management and recovery.
6. Lack of Improvement Despite Rest and Conservative Care
If symptoms persist despite rest and basic rehabilitation, more specialized treatments like vestibular rehabilitation or cognitive therapy may be necessary. If conservative measures aren’t working, professional evaluation is important to adjust the treatment plan.
Seeking help for PCS is crucial when symptoms persist longer than expected or impact daily life. Early intervention is key to preventing chronic issues and ensuring recovery. If symptoms don’t improve or worsen over time, or if you’re struggling with daily tasks, it’s time to reach out to our experts here at Keilor Road Physiotherapy. Early treatment leads to better outcomes and a quicker return to normal activities.
References
Al Attar, W. S. A., Mahmoud, H., Alfadel, A., & Faude, O. (2024). Does Headgear Prevent Sport-Related Concussion? A Systematic Review and Meta-Analysis of Randomized Controlled Trials Including 6311 Players and 173,383 Exposure Hours. Sports health, 16(3), 473–480. https://doi.org/10.1177/19417381231174461
Eliason, P. H., Galarneau, J. M., Kolstad, A. T., Pankow, M. P., West, S. W., Bailey, S., Miutz, L., Black, A. M., Broglio, S. P., Davis, G. A., Hagel, B. E., Smirl, J. D., Stokes, K. A., Takagi, M., Tucker, R., Webborn, N., Zemek, R., Hayden, A., Schneider, K. J., & Emery, C. A. (2023). Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis. British journal of sports medicine, 57(12), 749–761. https://doi.org/10.1136/bjsports-2022-106656
Giza, C. C., & Hovda, D. A. (2014). The new neurometabolic cascade of concussion. Neurosurgery, 75 Suppl 4(0 4), S24–S33. https://doi.org/10.1227/NEU.0000000000000505
Giza, C. C., Kutcher, J. S., Ashwal, S., Barth, J., Getchius, T. S., Gioia, G. A., Gronseth, G. S., Guskiewicz, K., Mandel, S., Manley, G., McKeag, D. B., Thurman, D. J., & Zafonte, R. (2013). Summary of evidence-based guideline update: evaluation and management of concussion in sports [RETIRED]: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 80(24), 2250–2257. https://doi.org/10.1212/WNL.0b013e31828d57dd
McCrory, P., Meeuwisse, W. H., Aubry, M., Cantu, R., Dvorak, J., Echemendia, R. J., Engebretsen, L., & Johnston, K. M. (2017). Consensus statement on concussion in sport: The 5th international conference on concussion in sport, Berlin, October 2016. British Journal of Sports Medicine, 51(11), 838-847. https://doi.org/10.1136/bjsports-2017-097699
National Institute of Neurological Disorders and Stroke (NINDS). (n.d.). Concussion. National Institutes of Health. Retrieved from https://www.ninds.nih.gov/health-information/disorders/concussion
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.