Concussions and Inception

Fun fact if you’ve seen Inception: the reason the characters use a sudden fall, or “kick” to wake up from a dream has to do with the vestibular system! That’s the part of your inner ear responsible for sensing motion, balance, and spatial awareness. While you sleep, especially in REM, your brain partially quiets the vestibular system so you’re not reacting to every shift or turn. But it’s not completely shut off. A strong enough signal, like the feeling of falling, can still get through and wake you up. In the movie, they say the sedations leave the inner ear unaffected, so the use of motion brings people out of the dream. It’s a cool example of fiction loosely tying back to how the body actually works.

Most athletes recover from a concussion and return to sport within 7 to 14 days, but that's not the case for everyone. Research shows that about 10–20% of people develop post-concussion syndrome (PCS), where symptoms like dizziness, headaches, brain fog, or fatigue last for weeks or even months. In the NFL, there were 182 concussions. So, thats 18-36 potential cases of PCS. These prolonged cases often involve issues with the vestibular system, the part of the inner ear and brain that helps control balance and eye movement.

In these situations, vestibular rehabilitation therapy (VRT) can be a key part of recovery. It helps retrain the brain to handle motion, balance, and visual tracking, which are often impaired after a concussion. So while many athletes can return to sport quickly, those with PCS may need a longer, individualized approach, and VRT can speed that process up when the vestibular system is involved.

A 2023 systematic review by Babula et al. looked at whether early vestibular rehabilitation therapy helps athletes recover more effectively after a concussion. The review found strong evidence that many athletes, up to 60%, experience vestibular or oculomotor symptoms after concussion, including dizziness, balance issues, and difficulty with visual focus. Traditionally, concussion care has leaned heavily on rest in the early stages, but this paper highlights that introducing vestibular rehab sooner, within days to a few weeks, can actually lead to faster and safer recovery. The studies reviewed showed that early VRT helped reduce symptoms like dizziness and headaches, improved balance and visual tracking, and even shortened the time it took for athletes to return to sport. Exercises typically focused on head-eye coordination, gaze stabilization, and gradually reintroducing motion. Importantly, starting rehab early was found to be safe and did not worsen symptoms. The authors concluded that early VRT should be considered a standard part of concussion management in athletes, rather than something delayed until symptoms persist.

Common exercises include gaze stabilization, where you keep your eyes fixed on a stationary target while moving your head side to side or up and down to improve visual clarity during motion. Balance training often involves standing on different surfaces, like firm ground or a foam pad, with eyes open or closed to challenge and strengthen your stability. Habituation exercises gradually expose you to movements or positions that trigger dizziness, helping your brain become less sensitive over time. Eye movement exercises, such as following a moving target or quickly shifting your gaze between points, improve visual tracking. These exercises are usually customized to your symptoms and progressively become more challenging.