Treating Dizziness After Concussion: Options Athletic Trainers Should Consider

Dizziness after a concussion can be more than just a temporary inconvenience—it often signals vestibular dysfunction that requires deliberate, targeted rehabilitation. For athletic trainers working on the front lines of injury recovery, understanding the full scope of evidence-based treatments is essential for effective care and timely return-to-play decisions.

Start with Objective Balance Assessment

In the early stages of concussion management, objective testing helps identify postural control issues that aren’t always evident through symptoms alone. Our mobile-based balance test provides trainers with an easy and accurate way to measure static balance deficits using just a smartphone or tablet. The score—calculated through built-in motion sensors during a series of stances—offers real-time insights into an athlete’s postural stability. Early identification of imbalance helps clinicians tailor the recovery plan, track progress, and minimize the risk of re-injury, all without needing bulky equipment.

Recognizing and Managing BPPV in Concussion

Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness following a concussion. This condition occurs when tiny calcium-carbonate crystals in the inner ear become dislodged, causing brief but intense spinning sensations triggered by changes in head position.

A comprehensive review published in Cureus emphasized that post-concussive BPPV is more common than previously thought and can be effectively treated with canalith repositioning maneuvers like the Epley procedure. Athletes who experience dizziness when rolling over in bed or looking up are strong candidates for screening, and prompt treatment can dramatically speed up symptom resolution and functional recovery (source).

Gaze Stabilization Therapy Reduces Dizziness

When athletes report dizziness during rapid head movements or difficulty focusing during motion, vestibular ocular dysfunction is often involved. A clinical trial published in the Journal of Sport Rehabilitation demonstrated that customized vestibular therapy focusing on gaze stabilization resulted in a 31% reduction in dizziness symptoms among youth athletes with concussions.

Exercises targeting the vestibulo-ocular reflex (VOR), such as moving the head while maintaining focus on a stationary object, are especially effective. These exercises are not only low-risk but can be incrementally and functionally progressed based on tolerance and measured improvements (source).

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The Role of Aerobic Conditioning in Recovery

Incorporating structured aerobic exercise has been shown to reduce dizziness and improve balance in patients experiencing prolonged post-concussive symptoms. A 12-week trial published in Frontiers in Neurology found that adults with persistent dizziness and balance issues experienced significant improvements after participating in a graded aerobic exercise program.

The study supported the use of sub-symptom threshold activities, such as light cycling or treadmill walking, early in the recovery process. This form of therapy not only helps with symptom reduction but also supports mood, energy levels, and overall physical conditioning—all of which can deteriorate with prolonged inactivity (source).

Combined Spinal and Vestibular Therapy

While vestibular therapy often receives the spotlight, cervical spine involvement is also a major contributor to post-concussion dizziness. A narrative review published by LIDSEN Neurobiology highlighted the benefit of combining cervical spine mobilization with vestibular rehabilitation. Interventions that address deep neck muscle control, cervical joint proprioception, and gaze stabilization in tandem are more effective than either approach alone. Athletic trainers can begin with gentle neck mobility work and progress to integrated tasks that involve coordinated and functional head movement, eye tracking, and balance retraining (source).

Multidisciplinary Approaches Improve Persistent Symptoms

When dizziness and balance issues persist beyond four to six weeks post-injury, a multidisciplinary approach becomes essential. A clinical overview from Frontiers in Neurology recommended combining vestibular-ocular therapy, balance training, and graded aerobic activity for patients experiencing long-term symptoms.

This integrated method allows providers to tackle multiple aspects of post-concussion impairment, from visual tracking to neurocognitive load, often resulting in meaningful symptom resolution and improved function across domains (source).

Managing Multisensory Impairments in mTBI

An exploratory study from New Zealand found that many individuals with mild traumatic brain injury present with multisensory deficits—including vestibular, visual, and proprioceptive challenges. Tailoring therapy to address these layers led to better outcomes in balance and dizziness resolution. Athletic trainers working with complex cases should consider integrating eyes-closed balance work, head movement challenges, and environmental stimuli to promote adaptation and recovery.

Rehabilitation that gradually exposes the athlete to the conditions of sport—such as noise, motion, and multitasking—mirrors the functional demands of competition and improves transferability of skills (source).

Virtual Reality: A Supplemental Option

While still an emerging treatment, virtual reality (VR) therapy is gaining traction for managing post-concussion dizziness. A meta-analysis evaluating VR-based vestibular rehab found positive effects on dizziness, gait, and balance in individuals with mild TBI.

VR training introduces visual and motion stimuli in a controlled way, which can help recalibrate the brain’s sensory integration. However, trainers and therapists should be cautious, as some patients may be sensitive to screen motion or experience cybersickness. VR should be used as a complement to—not a replacement for—traditional vestibular therapy (source).

A Practical Framework for Athletic Trainers

When treating dizziness after concussion, athletic trainers should begin with thorough assessment, including tools like a mobile balance test and the Vestibular/Ocular Motor Screening (VOMS). Identifying the root cause—whether BPPV, vestibular ocular dysfunction, cervical involvement, or multisensory impairment—guides targeted intervention. Early treatment should prioritize gaze stabilization, canalith repositioning (if indicated), and light aerobic activity. As the athlete progresses, balance drills should be layered with cognitive or visual tasks to mimic real-game/life conditions.

Athletic trainers should also work in tandem with physical therapists and vestibular specialists for cases that don’t resolve within two-four weeks. Objective measures such as Dizziness Handicap Inventory (DHI) scores, balance scores, and symptom logs can support clinical decisions and communicate progress clearly to coaches, parents, and medical teams.

Dizziness is a complex but highly treatable symptom of concussion. With the right assessment tools, informed treatment strategies, and timely intervention, athletic trainers can make a significant impact on recovery. By combining early balance testing, vestibular therapy, aerobic conditioning, and coordination-based exercises, athletes can return to sport not only symptom-free but with stronger postural control and readiness to meet the demands of competition.

Reviewed by Kim Wyand, PT, DPT

Director of Customer Experience, Sway Medical

Dr. Kim Wyand is a licensed physical therapist and concussion education specialist with more than a decade of experience in outpatient orthopedic and neurological rehabilitation. On top of leading the customer experience team, Kim works closely with Sway's research team, ensuring the platform remains grounded in research and consistently aligned with evidence-based best practices. She leads the development of tools and resources that support over 13,000 clinicians and athletic programs in delivering high-quality concussion care.