The Invisible Injury part two – Post Concussion Syndrome (PCS) ~ Surge Physiotherapy


In our first look at the ‘invisible injury’ we addressed concussions in their acute stage. As a quick refresher, a concussion is a traumatic brain injury induced by biomechanical forces. We also discussed that the majority of concussion (85 per cent of adult patients) symptoms resolve in 10-14days, and up to a month in children and adolescents.

There are approximately 15 per cent of people who don’t recover within one month of having a concussion. These individuals who still have persistent concussion symptoms >1month after onset are deemed to have post concussion syndrome (PCS).

Post concussion syndrome can impact a person’s life in a detrimental way. In addition to having to constantly manage concussion symptoms, which can intensify with normal activity, long-term PCS patients often have to restructure their lives to avoid activities and situations that cause symptoms to worsen.

Why do some people suffer from PCS and others don’t?

There is no single pathophysiological entity that causes persistent symptoms. However, there are likely some factors that play a predictive role in who may develop PCS/persistent symptoms.
1) Demographic Risk Factors
– Women and older individuals are more likely to develop persistent symptoms when compared to men and younger individuals, respectively

2) Medical Risk Factors
– Previous concussion history
– History of prolonged recovery
– History of mood, anxiety, sleep, learning or seizure disorders
– History of migraines or headaches

3) Injury Risk Factors
– Severity of impact
– Double impact
– Duration of initial symptoms
– Major visual symptoms soon after injury

Course of Action for Persistent Symptoms

Those suffering with persistent symptoms as a result of a concussion should be regularly monitored by their healthcare professionals to identify symptoms that are potentially treatable. Primary symptoms, such as depression, anxiety, irritability, sleep disorders, and post traumatic headaches, are to be addressed early on by a primary physician (i.e. doctor or nurse practitioner). Secondary symptoms, which can be treated from a physiotherapy or rehabilitation stand point, should be addressed thereafter. This includes difficulties with balance, dizziness/vertigo, cognitive impairment, fatigue, and tinnitus/noise intolerance.

A Physiotherapist Can Help

Clients with post-concussion syndrome (persistent concussion symptoms) are first assessed based on the screening of six different criteria, using 19 functional tests, that include: cervicogenic (neck), vestibular (inner ear), ocular motor control, verstibulo-ocular reflex, sensory integration and the autonomic nervous system. Thereafter a treatment plan is established based on the functional impairments outlined through the screening process; these impairments are then treated in order of priority using standardized exercise progressions. The overall goal is to increase functional capacity, while limiting the reproduction of symptoms.

Patients who receive education and treatment earlier are more likely to have fewer persisting symptoms later. Nonetheless, the priority for health care providers remains; managing symptoms and encouraging patients to gradually return to activity guided by symptom tolerance to prevent delays in recovery.

In case you missed it, read part 1, The myths and facts about concussion here.

For more information or to book an appointment call 705-380-3312 or visit the website . Surge Physiotherapy is located at 33 King William Street, Suite 204, in Huntsville. Office hours are flexible with evening appointments available (3x/week). Email – [email protected]

Stephanie is a bilingual, Registered Physiotherapist with the College of Physiotherapist of Ontario and the Canadian Physiotherapy Association who is committed to providing a hands on, personalized approach to physiotherapy.  

Stephanie, a native to the Huntsville community, developed a passion for health and wellness during her youth while competing in cross-country running, nordic skiing, and track and field. Stephanie has always had a strong caring nature and fell in love with the physiotherapy profession while volunteering at a physiotherapy clinic during high school and university. 

Stephanie continued to build on her passion for health care by attending McGill University and completing her Bachelors of Science in Kinesiology. During her Masters in Health Science of Physiotherapy, completed at the University of Ottawa, she completed internships in orthopaedic clinics, hospitals, home care, and neurology centres.