Concussion Rehab: A Practical Guide for Physios

Concussion management has changed.

For a long time, the message was simple: rest, avoid stimulation, and wait for symptoms to settle. But modern concussion rehab is no longer just about sitting in a dark room until the athlete feels better.

For physios, this is important. Concussion can feel intimidating because the symptoms are not always visible, progression can feel unclear, and return-to-sport decisions carry weight. But physios already have many of the skills needed to manage this well.

You understand graded exposure. You understand load management. You understand symptom monitoring. You understand how to progress rehab based on response, confidence, capacity, and the demands of the person in front of you.

The missing piece is often not the skillset. It is the framework.

In her Practical, Brooke Patterson shows how physios can apply familiar rehab principles to concussion management, with a focus on helping athletes safely progress from non-contact training back toward controlled contact.

If you want to know exactly how an expert helps athletes progress through return-to-contact rehab after concussion, watch Brooke’s full Practical HERE. With Practicals, you can be a fly on the wall and see exactly how top experts assess and treat specific conditions, so you can become a better clinician, faster. Learn more HERE.

 Concussion rehab is not passive anymore

One of the biggest shifts in concussion care is moving away from the idea that athletes simply need to rest until they are completely symptom-free.

Of course, the early phase still matters. Athletes need appropriate relative rest, monitoring, and medical guidance. They also need to avoid activities that put them at risk of another head impact while they are recovering.

But once they are ready, concussion rehab becomes much more active.

The athlete may progress through light aerobic activity, moderate aerobic activity, resistance training, non-contact skills, and eventually sport-specific training. At each stage, the physio is not just asking, “Are they symptom-free?”

They are asking whether the athlete can tolerate the current level of activity, whether symptoms return during or after the session, whether confidence is improving, and whether they are ready for the next demand of their sport.

This is where physios can play a bigger role than they might realise. When you look at concussion through a rehab lens, it starts to feel much more familiar.

The missed step: controlled contact

In the Practical, Brooke highlights a common gap in return-to-sport progression after concussion: athletes often move from non-contact skills straight into full contact training.

That jump can be too big.

An athlete might be symptom-free during daily life. They might tolerate aerobic exercise. They might even complete non-contact training without any issues. But full contact sport adds another layer: unpredictability, speed, decision-making, contact from different angles, body control, and confidence under pressure.

That is why Brooke focuses on controlled contact drills.

The aim is not to throw the athlete straight back into chaotic team training. It is to create a bridge between non-contact work and full contact exposure. This is a very physio-friendly idea: start with a controlled version of the task, monitor the response, then progress the demand.

Watch some of the early controlled drills demonstrated in Brooke’s Practical:

What should you actually assess?

Before progressing contact, Brooke shows how you can assess whether the athlete is ready for more demanding drills.

This does not need to be overly complicated. In a clinic or training environment, you can start with simple contact-based tasks that give you information about the athlete’s physical capacity, confidence, and symptom response.

Brooke demonstrates controlled bumping, tackling positions, rolling tasks, head control drills, and ball-handling with light contact. These tasks help you assess more than just fitness. You can observe whether the athlete is apprehensive, whether they tolerate head movement and rolling, and whether contact or vestibular demands provoke symptoms.

This is where concussion rehab becomes more than a checklist. The question is not simply, “Can they do the drill?” It is: how did they respond? Did symptoms return? Did confidence change? Did movement quality drop? Can we progress, or do we need to modify?

That is familiar territory for physios.

Contact can be progressed like any other exercise

One of the most useful parts of Brooke’s Practical is the way she frames contact as something you can regress or progress.

Instead of thinking of contact as all-or-nothing, you can treat it like any other rehab variable. You can change the speed, space, intensity, repetitions, rest periods, predictability, decision-making, and competitiveness of the drill.

For example, an athlete might start with controlled body contact in a small space, then progress to higher speed, larger distances, more reactive drills, repeated efforts, or more sport-specific scenarios.

You would not take a hamstring rehab patient from basic strength work straight into maximal sprinting under fatigue. You would not take an ACL rehab patient from controlled jumping straight into chaotic match play.

The same principle applies here.

If full contact training is the end goal, controlled contact exposure helps build the bridge.

See Brooke demonstrate how contact drills can be progressed in this clip from her Practical:

Make the drills match the athlete’s sport

Another important point from Brooke’s Practical is that concussion rehab should not be generic.

The demands of Australian football are different to basketball. Rugby is different to soccer. Combat sports are different again. That does not mean the physio needs to know every drill from every sport. It means the physio needs to understand what the athlete is returning to.

What type of contact happens in their sport? Do they need to tackle, be tackled, contest the ball in the air, box out, screen, wrestle, bump, land, roll, or change direction under pressure?

Once you know the demands, you can design a controlled version.

Brooke shows this clearly with examples from Australian football and basketball. In football, this might involve tackling positions, ground-ball contests, and aerial contests.

In basketball, it might involve rebounding, boxing out, screening, or navigating unexpected contact.

The exact sport may change. The principle stays the same: identify the demand, create a controlled version, monitor the response, and progress the task.

Reassess during and after contact exposure

A key part of concussion rehab is not just what happens during the session. It is also what happens after.

Brooke emphasises the importance of reassessing symptoms during the activity and making sure symptoms do not return the next day. This matters because an athlete may tolerate a drill in the moment, but respond later.

That response should guide the next step.

If the athlete tolerates the session well, you may progress the next contact exposure. If symptoms return, you may need to step back, modify the session, or return to an earlier phase of the progression.

Again, this is standard rehab thinking. You are not guessing. You are using the athlete’s response to guide progression.

Wrapping up

Concussion rehab can feel intimidating, especially when return-to-sport decisions are involved.

But physios should not see concussion rehab as completely outside their skillset. The core principles are familiar: staged progression, symptom monitoring, graded exposure, sport-specific demands, confidence-building, and response-based decision-making.

Brooke Patterson’s Practical gives you a clear framework for applying those skills to concussion rehab, especially when guiding athletes from non-contact training toward controlled contact and return to sport.

If concussion rehab still feels like “rest, wait, and hope,” this Practical gives you a more active way to think about it.

If you want to see exactly how an expert progresses athletes back toward contact after concussion, watch Brooke Patterson’s full Practical HERE.