A physiotherapist says extended dark-room rest is not needed after a concussion

Registered physiotherapist Sean Overin says anyone who may have a concussion should be assessed by a doctor or nurse practitioner, even if they feel mostly well. That is especially important for people taking blood thinners. A concussion does not require loss of consciousness, may not appear on a scan and can produce symptoms hours later, including headache, dizziness, poor sleep, difficulty concentrating, irritability and tearfulness.

Rest for the first day or two can be helpful, but Overin says weeks of near-total inactivity in a dark room can leave people feeling worse. Many people improve substantially within a few weeks. Rather than waiting to feel perfect, they should gradually resume daily life within their symptoms' limits.

He suggests using a traffic-light approach. Before an activity, rate symptoms from zero to 10. A green response is an increase of two points or less that settles within an hour, with the person still feeling well that evening and the next morning; that level can be repeated and gradually increased. If symptoms rise more or take longer to settle, stop and try a smaller amount next time.

People can begin with a short, easy walk on level ground, coffee with one friend, brief screen use and a regular bedtime. Once an activity is consistently manageable, change only one element, such as adding a few minutes, increasing the pace or spending time in a slightly busier room. People should not drive while dizzy or foggy, and should wait for a doctor's clearance before activities with a real risk of another head impact, including cycling, skiing and contact sports.

A severe or worsening headache, repeated vomiting, a seizure, trouble walking, increasing confusion, slurred speech, new weakness or numbness, or double vision requires a call to 9-1-1 or a trip to emergency. Overin recommends followup within one or two weeks. If symptoms are not improving, a doctor, physiotherapist or occupational therapist can assess contributing factors such as the neck, balance, sleep or stress. Symptoms lasting about four weeks or longer warrant a fuller assessment, he says.

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