Natural ways to improve balance after a concussion

I am Dr. Alireza Chizari, DC, DACNB, at California Brain & Spine Center in Calabasas. If you are looking for natural ways to improve balance after a concussion, the most useful answer is not to collect as many balance exercises as possible. It is to identify which balance system is underperforming and then challenge it at a level your nervous system can actually learn from.

After a concussion, balance can become unreliable even when strength is normal and routine imaging is reassuring. You may feel steady while sitting but drift when walking. Turning your head may make the world feel unstable. Closing your eyes in the shower may suddenly feel uncomfortable. A visually busy store can be harder than a quiet sidewalk.

Those differences matter because balance is not one sense. It is the brain continuously combining visual information, vestibular information from the inner ear, proprioceptive information from muscles and joints, and movement information from the neck and the rest of the body.

The goal of balance exercises after concussion is therefore not simply to make standing harder. The goal is to retrain the specific pieces of that system that are not integrating normally, then gradually put them back together under real-world conditions.

Before attempting more challenging drills, our existing guide on dizziness after concussion and why it happens explains why post-concussion dizziness can come from more than one system and why the trigger matters.

Why Does Balance Suffer After a Concussion?

The CDC includes dizziness and balance problems among common symptoms of mild traumatic brain injury and concussion and notes that symptoms can vary substantially from person to person. CDC concussion symptom guidance also makes clear that symptoms can change during recovery rather than follow one predictable pattern.

The vestibular system tells the brain how the head is moving

The vestibular organs in the inner ear detect head movement and orientation. The brain combines that information with eye movement and body-position signals to keep the visual world stable and maintain posture.

After concussion, vestibular symptoms may include dizziness, motion sensitivity, unsteadiness, blurred vision with head movement and difficulty tolerating movement through busy environments.

Vision can become too dominant

Some patients become unusually dependent on vision for balance. They may stand reasonably well with their eyes open on a stable floor but feel dramatically less secure when the lights are low, the surface changes, or the eyes close.

The problem is not necessarily weak legs. The nervous system may be relying too heavily on one sensory channel because the other balance inputs are less reliable.

Proprioception tells you where your body is without looking

Proprioceptive receptors in muscles, joints and connective tissues continuously inform the brain about body position. After injury, the brain may use that information less efficiently, particularly when visual or vestibular input is also disrupted.

This is one reason a person can feel very different standing on firm flooring compared with foam, grass, an uneven trail or another compliant surface.

The mismatch matters more than any one system

A 2026 review of post-concussive vestibular dysfunction describes balance problems after mild traumatic brain injury as a complex interaction involving central and peripheral vestibular function, cervical input and impaired sensory reweighting rather than a single isolated lesion. The review discusses mechanism-based vestibular assessment after concussion.

What Does Concussion Balance Dysfunction Look Like in Real Life?

Balance dysfunction after concussion is not always dramatic vertigo. Many patients use words such as floating, swaying, veering, disconnected, visually overwhelmed or uncertain on their feet.

One person may struggle when turning quickly. Another may be fine while walking straight but become unsteady when looking from side to side. Someone else may notice that carrying on a conversation while walking feels much harder than walking silently.

Which Balance Exercises After Concussion Are Actually Useful?

Vestibular rehabilitation has meaningful evidence behind it, although research does not support one universal protocol or dose for every patient. A systematic review and meta-analysis found vestibular rehabilitation was associated with improvement in perceived dizziness after mild traumatic brain injury, while also noting that the evidence base remains heterogeneous. Read the systematic review and meta-analysis of vestibular rehabilitation after mTBI.

Another systematic review of randomized trials found vestibular rehabilitation can be useful after concussion but emphasized the wide variation in exercise prescription, patient populations and outcomes. Review the randomized-trial evidence for vestibular rehabilitation after concussion.

1. Seated head and eye coordination

This is often a more controlled starting point than standing on an unstable surface. A patient may practice moving the eyes toward a target, moving the head while maintaining visual fixation, or coordinating eye and head movement in specific directions.

The point is not simply to make the patient dizzy. The clinician is looking at accuracy, visual stability, symptom response and whether the task becomes more efficient with practice.

2. Supported single-leg balance

Single-leg balance with support can challenge postural control without immediately removing the patient's safety options. A stable counter, rail or clinician may provide support while the nervous system learns to control smaller postural corrections.

Someone with significant dizziness, fall risk, lower-extremity weakness or recent worsening symptoms should not assume that single-leg standing is an appropriate independent home exercise.

3. Lateral weight shifts and controlled reaching

Lateral weight shifts teach the nervous system to move the center of mass deliberately rather than stiffening in place. Cross-body reaches and controlled X-pattern reaches can later add trunk rotation, visual targeting and coordination.

These exercises can be useful when someone moves cautiously because weight transfer feels uncertain after concussion.

4. Heel-to-toe and tandem walking

Heel-to-toe walking, also called tandem walking, narrows the base of support and increases the demand on dynamic postural control. It is commonly used as both an assessment and a rehabilitation challenge.

It should usually begin in a safe environment with access to support. Speed, head movement, visual demands and cognitive tasks can be added later rather than all at once.

5. Gaze stabilization while walking

Gaze stabilization while walking combines locomotion with the need to maintain clear vision during head movement. It can be helpful when patients say the environment feels unstable as they walk and look around.

This is a more complex task than seated gaze stabilization. It is generally progressed after simpler visual and vestibular tasks are reasonably controlled.

6. Marching on a compliant or unstable surface

Marching on an unstable surface changes the reliability of information coming from the feet and ankles, forcing greater sensory integration. It can be valuable for the right patient, but it also increases fall risk.

Foam surfaces, unstable pads and similar tools are not automatically safe home exercises after concussion. Support and clinician supervision matter, especially when eyes are closed or head movement is added.

7. Swiss ball weight shifts

Swiss ball weight shifts can introduce controlled trunk motion and body-position feedback while the person is seated. For selected patients, this may be a safer way to begin dynamic weight transfer than standing on an unstable surface.

The task can later become more complex by adding reaching or visual targets, but difficulty should be progressed according to control rather than novelty.

8. Cross-body coordination

Cross-body movement can combine proprioception, coordination, visual targeting and trunk rotation. Examples may include controlled cross-body reaches or stepping patterns that move across the body's midline.

These tasks become especially relevant when a patient's balance worsens as movement becomes multidirectional.

9. Eyes-closed balance work

Eyes-closed balance work removes the visual input many post-concussion patients have learned to rely on. That makes it diagnostically informative and potentially useful in rehabilitation.

It also makes the task less safe. Eyes-closed balance should not be performed casually on unstable surfaces or away from support simply because it appears on an online exercise list.

10. Dual-task balance training

Dual-task balance training combines movement with a second demand such as counting, answering questions, scanning the environment or carrying out a simple cognitive task.

Daily life is full of dual-task situations. You walk while talking, scan traffic while crossing a street, carry groceries while planning your next step, and navigate stairs while thinking about something else.

That is why cognitive and balance dual-task training can be important later in recovery. It should generally come after simpler movement patterns are safe enough to tolerate the added cognitive load.

How Do We Evaluate Balance and Coordination After a Concussion?

Balance exercises become much more useful when the exercise is tied to a finding.

This video shows one way neurological coordination and movement can be observed during an evaluation. The purpose is not to make every patient perform the same drill. It is to see where movement, visual input, balance and coordination stop working together efficiently.

At California Brain & Spine Center, a post-concussion balance evaluation may include neurological examination, eye-movement assessment, vestibular testing, positional testing when indicated, gait observation and computerized assessment of postural stability.

The clinic's Balance Disorder Therapy in Calabasas page explains the broader evaluation and rehabilitation process for patients whose main problem is unsteadiness or impaired postural control.

How Should Concussion Balance Exercises Progress?

The old version of this page included a fixed seven-day schedule and recommended automatically increasing difficulty each week. That looks practical on paper but does not reflect how neurological rehabilitation should be progressed.

A patient who cannot yet tolerate seated head movement should not progress simply because Monday became Friday. Another patient may be ready to progress faster in one domain but still need more time in another.

How Much Dizziness During Balance Exercises Is Too Much?

This is one of the most important questions because vestibular rehabilitation sometimes uses controlled exposure to movements that provoke symptoms.

The goal is not zero sensation during every exercise, but the goal is also not to trigger a major flare and simply call that neuroplasticity.

Symptoms should be interpreted in context. What matters includes how strongly the task increases symptoms, whether movement quality deteriorates, how quickly symptoms settle after stopping, whether the patient is safe and whether later activities that day are significantly affected.

Research supports individualized vestibular rehabilitation but does not establish one universal symptom number or recovery-time cutoff that is appropriate for every concussion patient. Earlier reviews also noted substantial variation in how vestibular exercises were prescribed and progressed. A systematic review of vestibular rehabilitation after concussion discusses this lack of standardized prescription.

Do Balance Exercises Work Better Than Rest Alone?

In the first phase after concussion, relative rest has a role. Staying completely inactive for prolonged periods is not the universal strategy it once was.

The CDC currently recommends easing back into regular activity after the first one or two days as tolerated and reducing activity when symptoms clearly worsen. CDC recovery guidance after mild TBI or concussion supports a gradual return toward normal activity rather than indefinite strict rest.

A systematic review and meta-analysis of physical interventions after concussion found evidence supporting subthreshold aerobic exercise and individually tailored physical interventions, with vestibular, cervical and oculomotor therapies forming part of the broader rehabilitation literature. Review the evidence for physical interventions after concussion.

That does not mean everyone should immediately begin difficult balance exercises. It means recovery is usually better thought of as gradual re-exposure to normal movement and activity rather than avoiding movement indefinitely.

When Should You Get Clinician Clearance Before Active Balance Rehabilitation?

Clinician clearance is especially important when balance loss is significant, the diagnosis is uncertain, symptoms are worsening, falls are occurring or the proposed exercise involves reduced visual input or unstable surfaces.

You should also be evaluated before assuming post-concussion imbalance is purely vestibular. Inner-ear conditions, cervical injury, medication effects, migraine, autonomic dysfunction and other neurological or medical causes can produce overlapping symptoms.

What Does a Post-Concussion Balance Evaluation Add?

Dr. Alireza Chizari, DC, DACNB, evaluates balance by trying to determine which sensory and neurological conditions make stability break down.

Standing still with both feet on a hard floor is only one condition. A more useful assessment may compare performance when vision changes, the support surface changes, the head moves, cognitive load is added or the patient has to coordinate walking with a second task.

Depending on the clinical picture, evaluation may include:

• Eye movement and gaze testing for fixation, pursuit, saccades and visual stability.
• Vestibular and positional assessment when dizziness suggests a vestibular contribution.
• Computerized postural stability testing to compare balance under changing sensory conditions.
• Dynamic gait assessment including head turns, directional changes and dual-task demands.
• Cervical and proprioceptive examination when neck injury or altered body-position feedback may contribute.
• Symptom response and recovery measurement so the exercise dose can be adjusted instead of guessed.

For patients whose post-concussion symptoms extend beyond balance, our Concussion Treatment in Calabasas page explains how visual, vestibular, cognitive, cervical and autonomic findings may be integrated into the rehabilitation plan.

For patients with prominent gaze instability, motion sensitivity or vestibular symptoms, the clinic's Vestibular Rehabilitation therapies page describes the role of gaze stabilization, habituation and visual-vestibular integration in more detail.

What Can Balance Recovery Look Like for Patients in Calabasas?

Balance recovery often becomes most noticeable outside the clinic.

A patient may first notice that the supermarket no longer feels as visually overwhelming. Turning the head while walking becomes less disorienting. Looking over the shoulder before changing lanes feels easier. Uneven ground requires less conscious attention.

Those changes are more meaningful than being able to perform a difficult exercise for its own sake.

For someone commuting through the West Valley, working long hours or trying to return to school or sports, the goal is not to become excellent at standing on foam. The goal is for the nervous system to handle changing sensory environments without consuming all of the patient's attention.

Why Does Dr. Chizari Measure Balance Before Progressing the Exercises?

From engineering to clinical neuroscience

Dr. Alireza Chizari, DC, DACNB, began his professional path with a B.S. in Electrical Engineering in Iran. He later earned a master's degree in Advanced Engineering & Management in the United Kingdom and worked as a Solar Engineer in the United States before moving into healthcare.

He earned his Doctor of Chiropractic degree from Life Chiropractic College West, trained in the Gonstead technique, and later pursued postdoctoral education in Clinical Neuroscience.

That engineering background still influences the clinical process: measure the system before deciding what should be adjusted.

For post-concussion balance rehabilitation, that means an exercise is not chosen because it looks neurological or difficult. It is chosen because the evaluation identified a reason to use it, and it is continued only if symptoms, performance or objective testing suggest the patient is moving in the intended direction.

You can read more about his background on the About Dr. Alireza Chizari page.

A Realistic Balance Recovery Pattern From the Clinic

I evaluated a patient from the Calabasas area after a concussion who could walk normally down a quiet hallway but felt unstable in stores, on uneven ground and whenever head movement was added to walking.

The frustrating part was that routine imaging had been reassuring and basic strength testing looked normal. The patient had started trying increasingly difficult balance exercises at home, including unstable surfaces and eyes-closed work, but the symptoms were becoming more unpredictable rather than more controlled.

The evaluation showed a different pattern. Balance deteriorated disproportionately when visual information was removed, gaze stability became less accurate with head movement, and cognitive tasks made walking less consistent. The problem was not a lack of effort.

We simplified the work first. The early rehabilitation focused on controlled eye-head coordination, supported weight shifting and gaze stabilization at a level that could be performed accurately. Tandem walking and head movement were added later.

Once those pieces became more stable, the exercises became more dynamic. Visual scanning was added during walking. The support surface was changed. Cross-body reaching and more complex stepping patterns were introduced. Dual-task work came later, once walking itself no longer required so much conscious effort.

Over time, the patient reported less disequilibrium in stores and better tolerance for walking while looking around. The objective balance findings also became more consistent under conditions that had previously been difficult.

There were still symptom fluctuations on tired days. Busy environments remained harder than quiet ones for a while. The improvement was gradual rather than dramatic, which is why reassessment mattered more than promising a fixed recovery date.

Frequently Asked Questions About Balance Exercises After Concussion

What to Remember About Improving Balance After a Concussion

The most useful natural ways to improve balance after a concussion are not the hardest exercises. They are the exercises that expose the right problem at the right level.

Balance depends on the brain combining vision, vestibular information and proprioception while also controlling the body in motion. A concussion can disturb how those systems are weighted and integrated. That is why seated head-eye coordination, supported single-leg work, tandem walking, gaze stabilization, sensory challenges, cross-body coordination and dual-task training may all have a role, but not necessarily at the same time or for the same patient.

Progress should be symptom-gated and measurement-driven rather than tied to a seven-day program or a fixed percentage increase. If a drill repeatedly causes a major flare or compromises safety, pushing harder is not automatically better rehabilitation.

If your scans were reassuring but your balance still changes with head movement, low light, busy environments, uneven ground or cognitive load, the next useful step may be identifying which part of the balance network is still underperforming.

California Brain & Spine Center | (818) 649-5300 | Calabasas, CA 91302