Ask a physio: After a concussion, the dark room was never meant to last

It is a wet October morning. The leaves on the front steps are slick, your foot goes, and the back of your head catches the railing on the way down. You sit there a moment, a bit stunned, a bit embarrassed. By afternoon there is a headache, a fogginess, and a sense that the kitchen lights are brighter than they should be.

You may have had a concussion. The first step is to get checked by a doctor or nurse practitioner, even if you feel mostly OK, and especially if you take a blood thinner.

After that, the advice many people still carry around is simple: lie down in a dark room and wait until you feel normal.

For the first day or two, easing off is reasonable. After that, the dark room can start working against you.

A few things are worth knowing. You do not need to be knocked out to have a concussion. It usually won’t show up on a scan. And symptoms can take hours to appear. Headache, dizziness, poor sleep, trouble concentrating, feeling irritable or teary. All common.

Here is what we actually know. Many people feel much better within a few weeks. A short stretch of rest helps. But weeks of doing very little tend to leave people feeling worse. Sleep drifts. Mood sinks. The world starts to feel loud, partly because you have been away from it.

So the plan is to ease back in, a little at a time. You don’t need to feel perfect first.

How much is enough? A traffic light helps. Before you start something, rate your symptoms from 0 to 10.

Green: they rose 2 points or less, settled within an hour, and you still felt fine that evening and the next morning. Repeat that amount, then build.

Amber: they rose more than that, or took longer to settle. Stop, let things calm down, and try a smaller dose next time. That is feedback, and it helps you learn how to move forward.

Red: a headache that is severe or getting worse, repeated vomiting, a seizure, trouble walking, growing confusion, slurred speech, new weakness, numbness or double vision. That is not a pacing question. Call 9-1-1 or go to emergency.

The phrase I give people is this: mild and brief is OK.

A little more headache that settles quickly is not a sign of harm. Everyday activity is very unlikely to injure a healing brain. And you don’t need to stir symptoms up for it to count.

In practise, start small. A short, easy walk on a level route. Coffee with one friend instead of a crowded dinner. Screens in short bursts. A steady bedtime. When something feels consistently manageable, change just one thing: a few more minutes, a little more pace, a slightly busier room. Hold off on driving while you feel dizzy or foggy, and on anything with a real risk of another knock, like cycling, skiing or contact sports, until a doctor has cleared you.

Plan a follow-up visit within a week or two. If things aren’t improving, you don’t need to wait a month to ask for help. A doctor, physiotherapist or occupational therapist can help sort out what is driving things, whether that is the neck, balance, sleep or stress. Symptoms that hang on past about four weeks deserve a fuller look. That is common, and it doesn’t mean you did anything wrong.

The goal isn’t to wait in the dark until you feel perfect. It is to step back into your life a little at a time, and let your brain catch up.

Sean Overin is a registered physiotherapist who coordinates the Chronic Pain Program at Tall Tree Health, which has a clinic in Port Coquitlam. This column is general information, not a substitute for individual medical advice.