Concussion - a mild traumatic brain injury from a direct blow to the head or a whiplash-style force - is far more common in Johor's sporting and working life than the formal statistics suggest.
Weekend football at Mount Austin, UTM futsal, school rugby, and motorcycle accidents on the Pasir Gudang Highway and Jalan Tebrau all produce cases.
Most get sent home with "rest for a few days and come back if it gets worse" - which is exactly the advice that research has moved away from.
Here's what the evidence now supports, and how we run return-to-play for Johor athletes.
What counts as a concussion
Concussion is a clinical diagnosis - there's no single test that confirms it.
The hallmark is a change in brain function after a head impact, even if the person doesn't lose consciousness.
Common symptoms:
- Headache, pressure in the head.
- Nausea or vomiting.
- Dizziness or balance problems.
- Feeling "in a fog" or slow to process.
- Memory problems, especially of the incident itself.
- Sensitivity to light or noise.
- Sleep changes (more or less than usual, trouble falling asleep).
Loss of consciousness happens in only about 10% of concussions.
Most athletes get up, walk off, and feel "a bit off" - that is still a concussion.
Red flags that mean A&E, not a physio
Go straight to HSA Sultanah Aminah, HSI, Regency Specialist, or KPJ Johor Specialist if any of:
- Loss of consciousness longer than 30 seconds.
- Seizure after the impact.
- Repeated vomiting.
- Worsening headache, confusion, or drowsiness in the hours after.
- Slurred speech, weakness on one side, or unequal pupils.
- Clear fluid from the nose or ears.
- Any significant neck pain with the head injury - cervical spine clearance needed first.
What the evidence has moved away from
"Cocoon therapy" - lying in a dark room for a week - used to be standard advice. Current international consensus (the Concussion in Sport Group guidelines, updated 2022) is now against it.
Prolonged rest worsens outcomes.
The window of strict rest is now 24–48 hours, followed by graduated sub-symptom-threshold activity.
What this means in practice: after the first 24–48 hours, the athlete should start light activity that doesn't provoke symptoms significantly.
Symptoms can be used as a guide - if an activity triggers mild symptoms that settle quickly, it's safe.
If symptoms worsen substantially or linger, drop back a level.
The 6-stage return-to-play protocol
Each stage lasts at least 24 hours. Progress only if symptom-free at the previous stage.
This is the international standard (CISG 6-step):
Stage 1 (days 1–2): symptom-limited activity
Daily activities that don't provoke symptoms. Walking around the house, light reading if tolerated, short screen time.
Stage 2: light aerobic exercise
Walking or stationary cycling at 70% of maximum heart rate. No resistance training. 15–20 minutes.
Stage 3: sport-specific exercise
Running, skating, or sport-pattern movement without head impact. No contact drills. 20–30 minutes.
Stage 4: non-contact training drills
More complex training - passing drills, agility work, resistance training. Progressive.
Stage 5: full contact practice
Return to normal training after medical clearance. Assess recovery during practice.
Stage 6: return to play
Competitive match play. Usually 1–2 weeks from injury for an uncomplicated concussion.
Vestibular and cervical rehabilitation
Around 30–40% of concussions produce persistent dizziness, visual disturbance, or neck-driven headache beyond 2 weeks.
These respond to targeted physiotherapy:
- Vestibular rehab - gaze-stabilisation exercises, habituation drills, balance retraining.
- Cervical rehab - manual therapy for the upper cervical joints, deep neck flexor training, scapular control work.
- Visual rehab - smooth-pursuit drills, convergence training, saccade work.
If symptoms persist past 10–14 days, a physiotherapist trained in concussion care is usually more useful than further rest.
How PhysioJohor matches post-concussion athletes
WhatsApp us with: date of injury, sport or context, symptoms present now, whether any imaging was done, and whether you've been medically cleared to begin stage 2.
We match to a physio with concussion-specific experience for the vestibular and cervical work - generic musculoskeletal rehab often misses the diagnostic piece that makes the symptoms click.
Related guide: Physiotherapy in Johor - complete guide