After Sports Concussion, Dizziness Needs a Profile—Not a Generic Exercise List

Dizziness after sports-related concussion should not lead automatically to one standard vestibular exercise programme. A 2026 clinical review recommends a profile-guided approach: take a careful history, screen vestibular and ocular-motor function, assess gait and balance, consider positional testing for benign paroxysmal positional vertigo, and use a fuller neurovestibular examination to distinguish likely contributors.

The answer-first clinical message is simple: dizziness is a symptom, not a diagnosis. Rehabilitation is more defensible when the likely source and provoking context are identified before the exercise is selected.

What does the review cover?

Kristin Israel and Kristen Steenerson published Management of Vestibular Symptoms in Sports-Related Concussion in the August 2026 issue of Neurologic Clinics. It is a practical narrative review intended to help clinicians organise screening, differential assessment and management.

The authors emphasise that vestibular symptoms are common after sports concussion and are associated with slower recovery and delayed return to play. Their early-screening approach includes the Vestibular/Ocular Motor Screen (VOMS), timed tandem gait and positional testing for BPPV. A detailed history and comprehensive neurovestibular examination then help distinguish different dizziness profiles.

The review places vestibular rehabilitation within a broader multimodal plan that may also include cervical management and graded aerobic exercise. Medication is described as an adjunct for selected conditions such as vestibular migraine and persistent postural-perceptual dizziness under appropriate medical supervision.

Why “dizziness” is not specific enough

Patients may use the word dizziness to describe spinning, light-headedness, imbalance, visual motion sensitivity, disorientation, unsteadiness or a feeling that the environment moves when the head turns. These descriptions do not point automatically to the same mechanism.

After concussion, possible contributors can overlap. BPPV requires a different assessment and management pathway from impaired gaze stability. Visual-motion sensitivity is not the same as cervicogenic dizziness. Vestibular migraine and persistent postural-perceptual dizziness introduce further diagnostic and medical considerations. Balance difficulty may also reflect sensory integration, gait, cervical, visual, vestibular or exertional factors.

A generic list of head and eye exercises risks missing those distinctions. The review instead supports matching the intervention to the profile identified through history, examination and referral where required.

What the early screen can add

VOMS is a symptom-provocation screen covering smooth pursuit, saccades, near-point convergence, vestibulo-ocular reflex tasks and visual-motion sensitivity. It can help identify domains that warrant closer assessment. It is not a stand-alone diagnostic test.

Timed tandem gait provides information about dynamic balance and gait performance under a standardised task. Positional testing is important when BPPV is suspected because canalith-related vertigo requires a specific diagnostic and management pathway rather than generic habituation.

Screening is the start of reasoning, not its conclusion. A positive or symptom-provoking result should be integrated with the history, neurological and cervical findings, medical status, examination of eye movements and vestibular function, and the pattern of triggers.

Practical takeaways for clinicians

1. Ask the patient to describe the sensation and trigger

Clarify whether the complaint is spinning, imbalance, visual instability, light-headedness or another sensation. Ask what provokes it: rolling in bed, looking up, walking in busy environments, reading, head movement, exertion or sustained posture.

2. Screen more than one domain

A symptom checklist alone cannot describe vestibulo-ocular function, gait or positional vertigo. Use appropriate screening tools within their scope and know when a more comprehensive assessment is required.

3. Consider cervical and non-vestibular contributors

Headache, neck pain, altered cervical movement, autonomic or exertional intolerance, migraine features and visual problems can coexist with vestibular symptoms. A profile may be mixed rather than neatly isolated.

4. Match the exercise to the finding

Gaze-stability work, habituation, balance tasks, canalith repositioning, cervical rehabilitation and graded aerobic exercise have different purposes. Selection, dosage and progression should reflect the assessment and symptom response.

5. Refer when the presentation exceeds scope

New neurological signs, atypical symptoms, hearing changes, severe or worsening headache, suspected central pathology, complex migraine or persistent unexplained dizziness may require medical, vestibular, neuro-otological, neuro-optometric or multidisciplinary input.

Where visual head-movement feedback fits

A head-mounted visual-feedback tool can make a clinician-selected head-control or tracing task visible. That may be useful within some cervical, gaze or balance programmes after the clinician has determined that the task is appropriate.

HeadX Kross does not perform VOMS, positional testing, timed tandem gait or a neurovestibular examination. It does not diagnose concussion, BPPV, vestibular migraine or any other source of dizziness. The featured review did not evaluate HeadX or show that a HeadX exercise accelerates recovery or return to play.

The defensible connection is about sequencing: assess the likely contributor first, then use the chosen tool as part of the intervention rather than allowing the tool to define the diagnosis.

Important limitations

This article is based on a narrative clinical review, not a new trial or formal meta-analysis. The review synthesises evidence and expert interpretation, but it does not provide a pooled effect size or a formal certainty rating in its abstract. Statements about early rehabilitation and faster recovery should therefore be traced to the underlying studies rather than treated as a result generated by this paper itself.

The focus is sports-related concussion. The same pathway may not apply unchanged to non-sport trauma, older adults, complex neurological presentations or dizziness unrelated to concussion. Screening tools also depend on training, protocol and context; they complement rather than replace clinical diagnosis.

In summary

Dizziness after sports concussion is not one clinical entity. The 2026 review supports a profile-guided approach that begins with a detailed description of symptoms and triggers, uses appropriate vestibular, ocular-motor, gait and positional screening, and progresses to targeted examination and management. For clinicians, the key discipline is to choose the exercise after identifying the likely profile—not to infer the profile from whichever exercise happens to provoke symptoms.

Suggested internal links

• Concussion Impairments and Rehabilitation: A Guide for Recovery
• Understanding Vestibular Disorders and Dizziness
• Chapter C: Functional Gaze and Head–Eye Coordination
• HeadX Kross

References

1. Israel KK, Steenerson KK. Management of Vestibular Symptoms in Sports-Related Concussion. Neurologic Clinics. 2026;44(3):471-486. PubMed
2. Galeno E, Pullano E, Mourad F, Galeoto G, Frontani F. Effectiveness of Vestibular Rehabilitation after Concussion: A Systematic Review of Randomised Controlled Trials. Healthcare. 2023;11(1):90.

This article is written for qualified clinical professionals. It is educational and does not constitute medical advice. The featured review did not evaluate HeadX or establish the clinical performance of a HeadX product.