Concussion Rehab for Kids: What Parents in East York Should Know.

Your kid takes a hit at practice. They pop back up, shake it off, tell the coach they're fine. That night at dinner they're a little quieter than usual. The next morning they say the classroom lights feel bright. By day three they can't get through a math worksheet without a headache and they're falling asleep at 7pm.

This is the pattern I see all the time at PRT East York. Not a dramatic sideline moment. Just a hit, a shrug, and then a week of "something's off." That's exactly what a concussion looks like in most kids, and what happens in the next 72 hours changes how quickly they get back to school, sport, and being themselves.

The good news is that the treatment has changed a lot in the last five years, and most of what you were probably told about concussions is out of date. This is a parent's guide to what to actually do.

What a concussion actually is

A concussion is a functional brain injury caused by a rapid acceleration or deceleration of the head. That includes direct hits, but it also includes whiplash-type impacts to the body where the head snaps forward or back. It is not a "brain bruise" and it does not require loss of consciousness. Most kids I see never blacked out. Some don't even remember the hit until you tell them.

What's happening under the hood is a temporary metabolic crisis in the brain. Cells get pushed into overdrive, neurotransmitters flood in, and the brain uses more energy while getting less blood flow for a period of days to weeks. That mismatch is what creates the symptoms: headache, brain fog, light and sound sensitivity, sleep changes, mood swings, dizziness, balance issues.

Almost every kid also has a neck component. The forces that shake the brain shake the cervical spine right along with it, and untreated whiplash can create headaches and dizziness that look identical to concussion symptoms weeks after the brain itself has healed. This part matters a lot for treatment, and I'll come back to it.

The first 48 hours: what to do, what to skip

If you suspect a concussion, the sequence is simple:

1. Remove them from play. Immediately. No "let's see if you feel better in a minute." The single most dangerous thing in youth concussion is going back in the same day. A second impact on an already vulnerable brain can be catastrophic. This isn't hypothetical, and it's the reason Ontario has strict return-to-play legislation.
2. Get them medically assessed. Family doctor same day if possible, walk-in clinic if not, or the ER if any red flag (see below). The medical assessment is what starts the paperwork trail and gives you the diagnosis you'll need for school and sport.
3. Relative rest for 24 to 48 hours. That means less screen time, less schoolwork, less intense physical activity. It does not mean total darkness and total shutdown. Light activity like a short walk is actually helpful within the first two days.
4. Watch them. Wake them up once during the night for the first night just to confirm they're rousable. After that, normal sleep is fine and actually restorative.
5. Start rehab early. Not immediately, but not two weeks from now either. The current evidence says that starting sub-symptom threshold activity and rehab within the first week leads to faster recovery than waiting.

Red flags that mean go to the ER right now

Concussion is usually not a medical emergency. But the things that look like a concussion can be, and it's worth knowing the difference. The list in the callout above is not exhaustive but it covers the main ones. When in doubt, ER. A CT scan that comes back normal is a much better outcome than missing a bleed.

For the more common non-emergency presentation, once they've been medically assessed and it's confirmed to be a concussion, the next question becomes: what do we do to get them better?

Why "rest in a dark room" is outdated

Most parents I see were told at some point that concussion means dark rooms, no screens, no school, no exercise, no anything, until all symptoms resolve. That was the standard advice for a long time. It's now considered harmful in most cases.

Here's why. Prolonged rest de-conditions the brain and the body. Kids who lie in the dark for a week get more anxious, sleep worse, lose fitness, fall behind at school, and end up with symptoms that persist long after the underlying injury has healed. What starts as a concussion becomes a mood and deconditioning problem stacked on top of a concussion.

The current international consensus (the Amsterdam statement in 2023 is the most recent) is short: brief relative rest for the first 24 to 48 hours, then gradual reintroduction of light activity at a level that doesn't significantly worsen symptoms. If cognitive work causes a symptom bump that resolves in 30 minutes, that's fine. If it causes an hour of new headache, back off a notch. The point is to keep nudging the system without overwhelming it.

The modern return-to-learn and return-to-sport protocol

There are two separate ladders running in parallel: getting back to school (return-to-learn) and getting back to sport (return-to-sport). Return-to-learn comes first. A kid should be handling a full school day symptom-free before they progress to the later stages of return-to-sport.

Return-to-learn (usually 1 to 3 weeks)

1. Daily activities that don't worsen symptoms (short walks, casual conversation, listening to music at low volume).
2. School activity at home (15 to 30 minute blocks of reading or light homework).
3. Part-time school with accommodations (shorter day, breaks, no tests, reduced screen time).
4. Full school with accommodations.
5. Full school, full workload.

Return-to-sport (starts after full school is tolerated)

1. Symptom-limited activity (light stationary bike, walking).
2. Light aerobic activity (jogging, brisk walking).
3. Sport-specific exercise (skating for hockey, running drills for soccer). No head impact.
4. Non-contact training drills (passing, shooting, complex movement).
5. Full contact practice, after medical clearance.
6. Return to game play.

Each stage is roughly 24 hours minimum. If symptoms show up during a stage, drop back one level and try again the next day. Most uncomplicated cases move through both ladders in two to four weeks. If a kid is still stuck at stage three or earlier after that window, that's when active rehab becomes especially important.

What we actually do at PRT after medical clearance

Once a kid has been medically assessed and given the go-ahead to start active recovery, this is where our part starts. Concussion rehab at PRT is not one thing. It's usually four things layered together, dosed to what the kid's presentation actually looks like.

1. Cervical spine and manual therapy

This is the one that surprises parents most. A huge chunk of "post-concussion" symptoms are actually coming from the neck, not the brain. The whiplash forces that caused the concussion also caused a soft tissue injury in the cervical spine, and untreated cervical dysfunction produces headaches, dizziness, and visual complaints that look exactly like concussion. Manual therapy, targeted mobilizations, and specific strengthening for the deep neck flexors is often the single fastest intervention for chronic symptoms.

2. Vestibular and oculomotor rehab

The vestibular system (your balance system) and the oculomotor system (how your eyes track and coordinate) both take a hit in concussion. Symptoms are dizziness with head turns, feeling off-balance, motion sickness in the car, trouble reading, and eyes that feel fatigued. Rehab is specific: gaze stabilization exercises, saccades and smooth pursuits, balance drills that progressively challenge the system. These are the exercises that get kids back to reading and screens without a headache.

3. Sub-symptom threshold aerobic exercise

The Buffalo Concussion Treadmill Test is the standard way to figure out a kid's heart-rate threshold for exercise without symptom exacerbation. Once we know that threshold, they exercise below it for 20 minutes a day, five days a week, and the threshold gradually climbs back up. This one intervention has some of the strongest evidence in concussion rehab for shortening recovery time.

4. Progressive return to sport

The last piece is walking them through the return-to-sport ladder above with actual coaching, not just a printed protocol. Sport-specific drills, reintroduction of contact when appropriate, and coordination with the coach so nobody rushes the timeline. This is where playing at a competitive level myself helps. I know what a drill actually looks like at practice, and I know when a coach is calling something "non-contact" that really isn't.

When to book

Book as soon as your kid has been medically assessed and cleared to start rehab, which is usually 24 to 72 hours after the injury. The earlier we start the graded exposure, the shorter the recovery. If a kid is more than two weeks out and still symptomatic, that's a signal to move faster, not slower. Persistent post-concussion symptoms respond well to active rehab, but the longer they linger untreated, the more layered the problem becomes.

We see kids for concussion rehab at both PRT East York (1400 O'Connor Drive) and PRT Scarborough (2100 Ellesmere Road). Every session is 1-on-1 with a chiropractor or physiotherapist, and we coordinate directly with your family doctor, the school, and the coach as needed.

Before your first visit, scroll to the symptom checklist below, have your kid fill it out, and bring a printed or screenshotted copy with you. It gives us a real baseline to track against.

For related reading on youth sports injuries this season, see back to school, back to sports for the other injuries we see most in kids returning to fall sports.

Dr. Peyton Smith, DC

Chiropractor · PRT East York & Scarborough

Peyton is a chiropractor at PRT and a former competitive soccer player. Her clinical work focuses on athletes and active people, including concussion rehab, whiplash, and return-to-sport programming for kids and teens.

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