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Post-Concussion Syndrome (PCS)

What Is Post-Concussion Syndrome

Post-Concussion Syndrome (PCS) is when a person continues to experience concussion symptoms past normal recovery times. There is no consensus on when concussion stops and when post-concussion syndrome begins; Therefore, it is extremely difficult to officially diagnose. Generally, PCS “starts” and concussion “ends” about 2-3 weeks after initial injury when/if symptoms remain. 

​Click Here to Learn More About Concussion

Click Here for a Pamphlet on PCS

Common symptoms

  • Headache

  • Fatigue

  • Insomnia

  • Noise and/or light sensitivity

  • Exercise intolerance

  • Cognitive intolerance

  • Psychological symptoms (depressed mood/irritability/anxiety

  • Cognitive problems (memory loss/ poor concentration/ and difficulty problem solving





Risk factors and Prevalence

More likely to sustain a concussion

  • Longer recovery periods

  • Female sex

  • Younger age

  • History of concussion

  • History of migraine

  • Diagnosis of a learning disability or ADHD

More likely to have a longer recovery period

  • Posttraumatic migraine

  • Immediate dizziness

  • Sub-acute fogginess

  • Difficulty concentrating

  • Vomiting

  • General dizziness

  • Cervicogenic dizziness

  • Nausea

  • Headache

  • Slowness

  • Imbalance

  • Light or noise sensitivity

  • Numbness

It is estimated that up to 40% of concussions will become post concussive



  • There is no test/image to 100% confirm, which is why baseline testing is important (lets us track symptoms and recovery)

  • Neurocognitive testing such as ImPACT is great for getting baseline data to compare when concussion/PCS is suspected


Post-Concussion Syndrome “Tracts”

PCS is subdivided into several “tracts.” These tracts are determined by the type of symptoms/deficits you are experiencing and have specific treatments associated with each tract. Many times people will fall into more than one PCS Tract, and treatment should reflect all tracts

Cognitive/Fatigue Tract

  • Risk Factors: learning disorders, ADHD, ADD

  • Common symptoms: difficulty with memory and concentration, difficulty following multi-step commands, fatigue, sleep disturbances

  • Treatment approaches: behavioral strategies/accommodations, monitored active rehabilitation, pharmacological, cognitive behavior therapy


Vestibular Tract

  • Risk factors: history of motion sickness

  • Common symptoms: loss of balance, feeling of imbalance, motion sickness, nausea, dizziness, fogginess

  • Treatment approaches: individually tailored vestibular therapy


Oculomotor Tract

  • Risk factors: amblyopia (lazy eye), strabismus (cross eye), family history of both

  • Common symptoms: eye pain/pressure behind the eyes, headache due to visual strain (reading/TV/computer or phone screen use), difficulty focusing (both physically and mentally), fatigue

  • Treatment approaches: vestibular therapy focusing on the impaired oculomotor deficits

    • *Neuro-opthalmologist treatment may be necessary in more severe cases


Anxiety/Mood Tract

  • Risk factors: history of mood disorders, family history of mood disorders

  • Common symptoms: increased anxiety, ruminative thoughts, hyper vigilance, sadness, helplessness, feeling of being overwhelmed, headache, sleep disturbances, dizziness, fatigue, fogginess

  • Treatment approaches: monitored active rehabilitation, regimented sleep schedule/diet/hydration/stress management, cognitive behavioral therapy, pharmacological


Post Traumatic Migraine Tract

  • Risk factors: history of migraine, family history of migraine

  • Common symptoms: chronic persistent headache, light sensitivity, noise sensitivity, nausea

  • Treatment approaches: strict behavioral management (sleep/diet/stress), pharmacological, monitored cardiovascular training


Cervical Tract

  • Risk factors: history of trauma to the neck (previous or at time of initial injury)

  • Common symptoms: headache that is occipital (back of head) in origin which may radiate to temples and eyes, neck pain/stiffness, fatigue, fogginess

  • Treatment approaches: cervical PT (manual therapy such as mobilization/manipulation/soft tissue release, AROM/PROM, stabilization training, and proprioceptive exercises


Physiological Tract

  • Risk factors: none

  • Common symptoms: headache, dizziness, fatigue, light sensitivity

    • These individuals will often have early symptom exacerbation with physical activity

  • Treatment approaches: monitored endurance training and strengthening as appropriate/tolerated


What Does the Research Say For Treatment?


  • First 7-10 days it is important to rest and allow the brain to recover as much as possible, but to not completely eliminate all inputs into the brain

  • Patients/athletes should limit their physical, mental, and emotional activities to moderate intensities (i.e., not too much, but not too little)

Post Concussion Syndrome

  • Emerging evidence suggests that rest is only beneficial in the acute stages of injury, and may even be harmful if utilized for too long of a period

  • Moderate activity is beneficial after the acute stages of injury, but over and under activity are both detrimental


General Treatment – WHAT YOU CAN DO

  • Limiting physical, mental, and emotional stresses BUT not completely eliminating these entirely

  • You want a balance of exertion and rest

  • Your brain responds to the stresses applied to it à some stress is good; too much can cause delays in healing



  • Determining which tracts of PCS you fall into

    • Cervical, vestibular, oculomotor, anxiety/mood, cognitive/fatigue, post-traumatic migraine, and physiological/exertional

  • Creating and implementing individualized plans of care such based on your PCS Tracts and your specific symptoms

  • EDUCATION! Helping you to understand your brain and how it responds to different stimuli and how to best manage your symptoms when they do happen


Let us help you with your recovery journey.

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