Sequence of Concussion Physical Therapy Treatments - Does It Matter?

Does the order of your concussion physical therapy treatments matter? Yes! A 2021 study showed the following treatment order to be the most successful for patients:

1. BPPV (benign paroxysmal positional vertigo)

2. Cervical

3. Visual

4. Vestibular

If BPPV, (this is the “whoa why is the room spinning when I roll over in bed?!” type of dizziness that we call positional vertigo) is present, we need to fix that first before proceeding to other interventions. If we don’t, we’re training on an unstable system and our brain won’t learn as effectively from our visual and vestibular therapy.

Literature says that 20-30% of people have post-traumatic BPPV during their concussion recovery. These folks are harder to treat because post-traumatic BPPV is more likely to occur in both ears, occur in multiple canals, reoccur and require multiple treatments.

Once we’re on solid ground with those two domains, visual and vestibular rehabilitation will “stick” and be much more successful.

Recovery from a concussion is nuanced and complicated. Reach out to a concussion physical therapist!