PCS Dizziness Comes From Treatable Mechanical Causes The vestibular system can be retrained. Concussion damages the vestibular system, but the damage is functional rather than permanent in most cases. Specific exercises retrain the system to function accurately. The retraining is what vestibular rehabilitation provides. No medication can replicate this retraining (Patricios et al., 2023). Cervical dysfunction contributes to dizziness. The upper cervical spine has dense proprioceptive input that integrates with vestibular processing. Cervical dysfunction produces dizziness directly (cervicogenic dizziness). Treating the cervical dysfunction resolves this component. Medications do not address cervical mechanics. Oculomotor dysfunction produces dizziness. The visual and vestibular systems coordinate to maintain spatial orientation. Oculomotor problems from concussion disrupt this coordination, producing dizziness. Vision therapy or vestibular therapy targeting oculomotor function resolves this. Medications cannot retrain eye movements. Autonomic dysregulation produces position-related dizziness. Orthostatic intolerance and impaired cerebral autoregulation produce position-related dizziness. Sub-symptom aerobic exercise rebuilds autonomic function. The exercise prescription is a form of physical therapy. Medications can mask but not address the underlying autonomic dysfunction. What Medications Do and Do Not Do Vestibular suppressants (meclizine, diazepam) reduce dizziness sensation temporarily. The medications suppress vestibular system function, reducing the dizziness signal. But the suppression prevents the vestibular system from receiving the input it needs to recalibrate. Patients on these medications during recovery often have prolonged dizziness because the system never recalibrates. Anti-nausea medications (ondansetron, promethazine) reduce nausea but not dizziness. The dizziness produces nausea. Treating the nausea symptom does not address the dizziness. Useful for severe nausea episodes but not for the underlying problem. Migraine medications affect migraine-related dizziness. Some PCS patients develop migraine-related dizziness (vestibular migraine). Migraine prevention medications can help this specific component. Even here, the medications work better combined with vestibular therapy. Anxiety medications reduce anxiety-related dizziness. Some dizziness reflects anxiety responses. Treating the anxiety reduces this component. Best combined with addressing the underlying mechanical contributors. No medication produces lasting resolution. The medications provide temporary symptom reduction. The underlying dysfunction persists. Discontinuing the medication returns symptoms to pre-medication baseline. Physical therapy produces actual recovery rather than symptom masking. Mobility Support for PCS Dizziness JME 155 Diaphragmatic breathing supports the autonomic regulation that affects orthostatic stability. Position-related dizziness improves with consistent breathing practice. 10 breaths every 60-90 minutes, plus before any position change that triggers dizziness. JME 14 Chin tucks specifically address the upper cervical proprioception that contributes to dizziness. The deep cervical flexor strengthening is part of cervicogenic dizziness treatment. 10 repetitions with 5-second holds, multiple times daily. JME 1 Cervical rotation directly addresses the cervical proprioception that integrates with vestibular function. The exercise is foundational for cervicogenic dizziness treatment. 10 repetitions each direction, slow and controlled. JME 150 Thoracic rotation supports the cervical function that influences dizziness. Without thoracic mobility, the cervical compensation prolongs cervicogenic symptoms. 8 repetitions per direction. Start your 3-day free trial for dizziness-focused mobility programming. The Physical Therapy Approach to PCS Dizziness Step 1: Comprehensive assessment. Vestibular therapist tests: vestibular ocular reflex, gaze stability, balance under various conditions, motion sensitivity, positional testing (BPPV), and cervical involvement. The assessment identifies specific deficits to address. Step 2: Gaze stabilization exercises. Focus on a target while moving head. The exercise retrains the vestibulo-ocular reflex that concussion impairs. Progress from slow to fast head movements, from stationary to moving targets. Typically 2-3 times daily for several minutes. Step 3: Habituation exercises. Repeated exposure to movements that produce dizziness. The exposure produces neural adaptation that reduces the dizziness response. The exercises must produce mild symptoms to be effective (sub-symptom does not work here). Step 4: Balance training. Progressive balance challenges: stable surface, foam surface, eyes closed, dynamic movement. The training rebuilds the multisystem integration that balance requires. Step 5: Cervical treatment. Manual therapy addressing upper cervical joint dysfunction. Deep cervical flexor strengthening. Postural correction. Addresses the cervical contribution to dizziness. Step 6: Functional integration. Practice the activities that produce dizziness in real-world contexts. Grocery shopping, driving, work activities. The functional practice generalizes the rehabilitation benefits. Daily Movement Routine JME 3 Lateral cervical flexion daily addresses the cervical contribution to dizziness. The mobility supports the cervical recovery. 8 repetitions per side with 15-second holds. JME 42 Shoulder circles maintain upper-body mobility that supports cervical function. 10 repetitions each direction. JME 15 Cervical extension supports the cervical curve that influences dizziness. Daily extension supports recovery. 8 repetitions. JME 151 Lateral side bends with breathing combine mobility and autonomic regulation. Both contribute to dizziness recovery. 8 repetitions per side. Address dizziness causes with simplmobility's mobility programming. Finding the Right Provider Look for "vestibular rehabilitation" specifically. Not all physical therapists provide vestibular therapy. Vestibular Competency Certificate (VCC) or APTA Neurology Section certified specialists have specific training. Ask about training before scheduling. Concussion-specific PT differs from general PT. PT with concussion expertise understands the combination of cervical, vestibular, and autonomic contributors. General PT may address one component without integrating the others. Find concussion-specialized practitioners. Insurance typically covers PT for PCS. Concussion-related dizziness is a medical condition. PT for the condition is typically covered. The number of visits may be limited; use them strategically. Expect 8-12 sessions for most cases. Typical vestibular rehabilitation takes 6-12 sessions over 8-12 weeks. More complex cases require more sessions. Home exercise compliance affects outcome significantly. When Medications Have a Role Acute severe dizziness episodes. Vestibular suppressants for 2-3 days of severe acute symptoms. The brief use does not prevent recovery. Long-term use does. Vestibular migraine component. If migraine is contributing to dizziness, migraine prevention medications help. Combined with vestibular therapy for optimal results. Anxiety component. If anxiety is amplifying dizziness, SSRIs or similar may help. The medication addresses one component while PT addresses others. Severe sleep disruption from dizziness. Temporary sleep aids may be appropriate while PT addresses the dizziness. Long-term sleep aids produce dependence. How long until physical therapy reduces my dizziness? Most patients see substantial improvement within 4-6 weeks of consistent vestibular rehabilitation. Full resolution typically takes 8-12 weeks. Compliance with home exercises affects timeline significantly. Patients who do home exercises consistently see faster improvement than those who only do in-clinic work. Should I take my dizziness medications during PT? Vestibular suppressant medications interfere with PT effectiveness. Discuss with the prescriber about tapering off during vestibular rehabilitation. Other medications (migraine prevention, anxiety) typically continue during PT without interfering. What if PT does not help my dizziness? Persistent dizziness despite proper PT suggests untreated contributors. Additional evaluation may be needed: cardiology for autonomic causes, ENT for inner ear, neurology for central causes. Sometimes the diagnosis is incomplete and additional treatment targets need identification. References Patricios, J. S., et al. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695-711. PubMed Treleaven, J. (2008). Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Manual Therapy, 13(1), 2-11. PubMed