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Problems with balance are very common following a concussion. For good balance you need input from vision, inner ear and the somatosensory systems. 

Many people with imbalance after a concussion have associated visual impairment as well. Dizziness however is more likely to take a longer recovery time. You need to address this quickly as it can make you “feel bad� and can worsen other symptoms such as anxiety, fatigue and even difficulty concentrating. Ongoing dizziness may be the reason why you feel unable to go to school or work.

 This information sheet is for educational purposes only. For further information regarding this topic, please talk to your child's health care team.

There are many causes of imbalance, and we will focus on only those that are important and seen following a concussion.

Balance is the ability to keep your body centred over your feet. The ability to maintain your balance is determined by many factors, including your physical strength and coordination, your senses, and your cognitive or thinking ability.

Postural hypotension

A drop in blood pressure when standing or sitting up suddenly can make you feel lightheaded and dizzy. You may have difficulty standing up (transient orthostatic intolerance) as a result of your concussion. This needs to be treated by an experienced clinician.

Vision impairment

Eyesight is one of the key senses you need to keep your balance. Eyesight problems such as double vision and visual instability can make your balance worse.

Vestibular impairment

Your inner ear contains many tiny organs that help you keep your balance (called the vestibular system). Your inner ear has three loop-shaped structures (semicircular canals) that contain fluid and have fine, hair-like sensors that monitor the rotation of your head. It also has other structures (otolith organs) that monitor linear movements of your head. These otolith organs contain crystals that make you sensitive to movement and gravity.

If your vestibular system is damaged from a concussion, you may have problems with balance, dizziness, or a sudden sensation that either you’re spinning or that your head is spinning. This is called vertigo. Positional vertigo may be associated with vestibular system damage and should be treated by an experienced clinician.

Children can have positional vertigo post-concussion, which is not the result of vestibular system damage. These children have a high association with underlying migraine headache.

Sensory impairment

Problems with your ability to sense things (sensory integration), may be impaired following a concussion. The balance system needs dynamic flexibility and precise timing of neural transmission. Following a concussion, sensory information may be misinterpreted, and this may lead to an illusion of movement, motion intolerance, or even a sense of nausea or dizziness.

The following are ways you can improve your balance following a concussion. Specific exercises will be described for:

• Habituation
• Gaze
• Balance training and co-ordination

Most people with a concussion recover within 4 weeks, sometimes even quicker.

In a small number of cases however, dizziness may continue. For these people special treatment may be required. This is called vestibular therapy or vestibular rehabilitation. This is done by specially trained therapists and you will need a referral from your doctor.

Goal: To gently re-train your brain so that you are not dizzy or nauseous when moving.

Aim to look in different directions, as shown above, slowly moving both your head and neck.

You can also try short exposures to light and noise � e.g. shopping centre, screen time.

These exercises help to improve control of eye movements so vision can be clear during head movement. These are helpful for people who report problems seeing clearly because their visual world appears to bounce or jump around, e.g. when reading or trying to identify objects when moving.

Goal: To reduce dizziness when focusing on a point.

Goal: To increase balance.