The REAL Reasons Your Balance is Off After a Concussion (And How to Fix It)
So your balance is off—and it’s driving you nuts.
You might feel it when you’re working out, turning sharply on the ice, or standing up too fast. You might feel off, floaty, unstable, or dizzy—and the longer it sticks around, the more it chips away at your confidence.
If you’ve heard people say it’s “just your inner ear” or that “your balance should be fine by now,” I get your frustration. The truth is: concussion-related balance issues are real, common, and fixable—but only if you know what to look for.
Balance is more than just strong legs and good reflexes. After a concussion, it becomes a whole-brain problem—tied to blood flow, eye movements, neck function, and even anxiety. In this post, I’ll walk you through the five most overlooked reasons your balance might still be off after a concussion—and, more importantly, how to fix them.
1. Autonomic Nervous System Dysfunction (Dysautonomia)
After a concussion, your autonomic nervous system—the part that controls blood flow, heart rate, and blood pressure—can get knocked off balance (no pun intended). This creates a mismatch between what your brain needs and what your body delivers. Result? You feel dizzy, foggy, off-balance, or lightheaded—especially when standing, training, or changing position quickly.
What to Watch For:
Dizziness or nausea with exertion
Feeling worse with standing or after workouts
Symptoms that flare between 50–70% of your HRmax
What Helps:
Buffalo Concussion Treadmill Test (BCTT): This is the gold standard to find your current threshold for safe exercise.
Personalized aerobic rehab (sub-symptom threshold): Done consistently, it helps retrain blood flow regulation and autonomic control.
Hydration, sleep, and consistent movement—not hibernation.
2. A Dysfunctional Vestibular System
Your vestibular system (located in the inner ear and brainstem) acts like your internal gyroscope. It tells your brain where your head is in space. If that system is off, your body will feel off—even if your legs are strong and your vision is working.
After a concussion, even small disruptions in the vestibular-ocular reflex (VOR) can throw your balance off, especially in motion-heavy sports like hockey, soccer, or gymnastics.
What to Watch For:
Dizziness with head turns or in busy environments
Nausea when scrolling or watching fast-moving video
Feeling “off” even though your vision exam was normal
What Helps:
VOMS Test (Vestibular Ocular Motor Screening): A clinical tool that screens for vestibular dysfunction through smooth pursuit, convergence, and VOR testing.
Targeted vestibular rehab: Gaze stabilization, habituation, and dynamic balance work under a trained provider.
🧠 Important note: The VOMS is a quantitative test, not qualitative. It tells us which system(s) - eyes or ears - is dysfunctional but doesn’t give us much color or detail as to why. For example, do saccades make you dizzy because you “undershoot” the target, the background motion bothers you, both, etc.?
3. Cervical Spine and Proprioceptive Dysfunction
Your neck isn’t just passively, mechanically holding your head up—it’s loaded with receptors that help your brain know where you are in space. After a concussion, if your neck is stiff, injured, or overloaded, it can feed your brain bad information, triggering imbalance, dizziness, or even nausea.
What to Watch For:
Balance issues that worsen with neck movement
Headaches, tension, or fatigue in the neck/shoulders
Symptoms during the Cervical Flexion-Rotation Test or Smooth Pursuit Neck Torsion Test
What Helps:
Cervical spine rehab: manual therapy, deep neck flexor training, and posture re-education.
Integration with vestibular rehab, especially for those with COR/VOR mismatch (common in chronic cases).
4. Blood Sugar and Metabolic Factors
Your brain runs on oxygen and glucose. If your blood sugar crashes or fluctuates wildly during the day—especially post-exercise—you’re more likely to feel dizzy, weak, or mentally off. This can amplify other symptoms and even mimic autonomic issues.
What to Watch For:
Feeling shaky, anxious, or foggy before meals
Crashing after training
Balance or dizziness symptoms that follow inconsistent eating
What Helps:
Prioritize balanced meals: include quality protein, healthy fats, and slow carbs.
Don’t train fasted or under-fueled during concussion recovery.
Pay attention to energy dips that correlate with symptom flare-ups.
5. Psychological Overload: Stress, Anxiety, and Performance Pressure
Concussion doesn’t just affect the body—it affects the nervous system, psychology, and self-identity. If you’re living in fight-or-flight mode, your balance will suffer. Why? Because anxiety tightens your breathing, alters your posture, and hijacks the same neural systems that control balance and focus.
Athletes often downplay this, but your brain doesn’t. Especially if your recovery has taken longer than expected.
What to Watch For:
Feeling unsteady in crowds, noise, or under pressure
Getting caught in “symptom-chasing” or over-Googling
A loop of “symptom → anxiety → worse symptoms → more anxiety”
What Helps:
Cognitive-behavioral strategies: reframing, journaling, grounding exercises
Working with a sports psych or therapist who understands concussion
Cutting the mental clutter and simplifying your recovery plan
Final Thoughts: Balance Is a Full-System Problem (And That’s a Good Thing)
Your balance problems aren’t just “in your ear.” They’re part of a complex recovery process involving your brain, spine, metabolism, and nervous system. That might sound overwhelming—but it also means there are multiple entry points for recovery.
If you’ve been spinning your wheels with vague advice or incomplete rehab, it might be time for a more structured, systems-based approach.
Want to go deeper?
Check out these related reads:
Let’s Build a Recovery Plan That Actually Moves the Needle
Whether you’re an athlete, a parent, or someone just trying to get their life back after a concussion, I’m here to help you figure out what’s working, what’s not, and how to move forward with clarity.
Book Your Concussion Recovery Consult → drheisig.com/appointments
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