Exercises for TBI Rehabilitation: A Practical, Step-by-Step Guide (with Integrative Chiropractic Support)

 

Why exercise matters after TBI

After a TBI, the brain and body can feel “out of sync.” Exercise helps on three fronts:

1. Physical – restores endurance, mobility, and strength, making daily life easier.

2. Balance & vestibular – retrains vision–inner ear–neck systems to reduce dizziness and falls.

3. Cognitive – challenges attention, memory, and problem-solving to promote neuroplasticity, the brain’s ability to rewire through repetition and progressive challenge (Flint Rehab, 2025). Flint Rehab

Large rehab organizations and professional groups recommend graded, symptom-limited activity—starting light, then progressing as tolerated. Many programs aim for the same public-health targets used for the general population (with clinical judgment), such as ~150 minutes/week of moderate cardio in 10-minute bouts, spread across the week (Physio-Pedia summary of TBI activity guidelines). Physiopedia

Key safety idea: move gradually. After the first 24–48 hours of relative rest for concussion, most people benefit from a cautious, step-wise return to activity instead of prolonged bed rest. Light walking early on is linked to faster recovery for many patients (Concussion Alliance; bpacNZ clinical guidance). Concussion Alliance+1

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How to progress safely (the “RPE + symptom” rule)

Use a 0–10 effort scale (Rate of Perceived Exertion, RPE). Start at RPE 2–3 (very easy). Increase time or difficulty only if:

• Symptoms do not worsen more than 1–2 points and settle within 1 hour after exercise.

• Balance remains safe (use a counter, rail, or a spotter as needed).

• You can talk in full sentences while moving (for aerobic work).

If symptoms spike (headache, dizziness, nausea, visual strain), drop back, rest, and retry at a lower level or with more support. This graded approach is echoed in patient-facing and clinician resources for TBI rehab. neuropt.org+1

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The exercise toolkit (with progressions you can scale)

Below are the core categories most TBI programs include. Choose 1–2 items from each category to build your week. When in doubt, consult with your clinician to clarify your plan.

1) Cardiovascular (aerobic) activity

Goal: improve endurance and help regulate autonomic function (e.g., heart rate, blood pressure), which often feels “off” after TBI.

Start here (RPE 2–3):

• Walk 5–10 minutes on flat ground.

• Recumbent bike or elliptical for 5–10 minutes.

• Pool walking (in the shallow end) for gentle support.

Build up: add 2–5 minutes every few sessions until you reach 20–30 minutes most days. Try intermittent intervals (1 minute easy, 30 seconds slightly brisk) as tolerated. Major TBI guidelines and summaries recommend engaging in activities such as walking, cycling, swimming, and other low-impact exercises, aiming for ~150 minutes per week if appropriate. Physiopedia

Tip: Some concussion clinics like aerobic first, then cognitive sessions, because a short cardio bout can “prime” attention and readiness (Cognitive FX). cognitivefxusa.com

2) Strength training

Why: combats deconditioning, improves walking, and protects joints.

Foundational moves (2–3 days/week, 1–3 sets of 8–12 reps):

• Sit-to-stand or squats (use a chair to guide depth).

• Hip hinges (hold a counter, keep back neutral).

• Rows with a band (squeeze shoulder blades).

• Wall push-ups (progress to counter, then floor).

Home programs for TBI commonly include seated hip rotations/abduction, marching, trunk extension, weight shifts, and heel-to-toe raises—all of which are scalable from seated to standing (Illinois CMS; Flint Rehab). Illinois CMS+1

Progression ideas:

• Add a band or light dumbbells.

• Move from supported → unsupported standing.

• Pair with a dual-task (counting by 3s while squatting).

3) Balance & vestibular retraining

Why: Dizziness, unsteadiness, and visual motion sensitivity are common after TBI. Vestibular rehab uses graded eye-head-body drills to recalibrate the system. Physiopedia

Start here (near a counter or with a spotter):

• Static stance progressions: feet apart → feet together → tandem stance (heel-to-toe) → single-leg stance, 20–60 seconds each. Add eyes-closed only when safe. (Flint Rehab). Flint Rehab

• Weight shifts forward and backward, as well as side to side (Illinois CMS, Flint Rehab). Illinois CMS+1

• Gaze stabilization: hold a target at eye level an arm’s length away; keep eyes on the target while slowly turning head left/right, then up/down (Flint Rehab; Headway balance resources). Flint Rehab+1

Progressions:

• Narrow your base (tandem → single leg).

• Add head turns or eye-tracking while balancing.

• Introduce uneven surfaces or walking with turns.

• Try short dual-task layers (e.g., naming vegetables A–Z while performing a tandem stance).

4) Coordination & agility (simple “neuro” drills)

• Cone taps: set 3–4 objects and tap them in a pattern.

• Ladder steps or chalk boxes: slow, precise foot placements.

• Ball toss: two-handed → one-handed → non-dominant hand to challenge brain-hand mapping.

• Metronome marching: step to a beat; adjust tempo to force attention and timing.

These simple patterns support motor planning and attention—core parts of neuroplastic retraining (Flint Rehab neuroplasticity primers). Flint Rehab

5) Flexibility & posture

• Pectoral doorway stretches, upper-trap/levator stretches, and thoracic extension over a towel roll can help alleviate postural overload after prolonged screen time.

• Breathing practice (diaphragmatic, 5–10 slow breaths) reduces neck and jaw guarding that contributes to headaches and dizziness (many concussion clinics incorporate calming breathwork as part of their treatment plan). Toronto Concussion Clinic

6) Cognitive training (at home and with therapists)

Principle: short, focused, progressive challenges that are new, interesting, and just hard enough. Options include:

• Attention: “spot the difference,” timed word-search, listening for a target word in an audio clip.

• Working memory: N-back-style tasks (start with 1-back), spaced retrieval using flashcards.

• Executive function: plan a 3-step meal, schedule a day in a calendar, or do route planning.

• Language: describe a photo in 5–6 sentences; summarize a 2-minute video.

• Sensory novelty: use your non-dominant hand for safe tasks (brushing teeth, stirring), which many TBI resources suggest to increase novelty and cross-wiring (Great Speech; Flint Rehab). Great Speech+1

Start slow and scale up—a common recommendation in concussion/TBI cognitive-exercise guides. concussioncare.co.nz

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A simple 7-day starter template (scale each block to your level)

Before you begin: If you have red-flag symptoms (worsening severe headache, repeated vomiting, seizure, severe neck pain, slurred speech, new weakness/numbness, or confusion), seek medical care first. Then return to exercise with professional guidance.

• Day 1 (Mon) — Walk 10–15 min (RPE 2–3); sit-to-stands 2×8; gaze stabilization 2×30s; journal writing 10 min.

• Day 2 (Tue) — Recumbent bike 12–15 min; rows + wall push-ups 2×10 each; tandem stance 3×30s; spaced-retrieval cards 10 min.

• Day 3 (Wed) — Pool walk 15–20 min; hip hinges 2×8; weight shifts 2×30s; non-dominant-hand task 5–10 min.

• Day 4 (Thu) — Walk 15–20 min; band squats 2×10; gaze stability with head turns 3×20s; plan a simple meal 10 min.

• Day 5 (Fri) — Elliptical 10–15 min; rows + counter push-ups 3×10; tandem → eyes closed (supported) 3×20s; word-list recall 10 min.

• Day 6 (Sat) — Free choice low-impact cardio 20–30 min (yoga/Tai Chi encouraged); thoracic stretch + diaphragmatic breathing 5–10 min; board game or puzzle 20 min.

• Day 7 (Sun) — Active recovery: gentle walk 10–20 min; longer breathing session 10 min; reflection: note your best/worst symptoms, set one small goal for next week.

These elements mirror common at-home lists from patient resources (Illinois CMS; Flint Rehab), as well as well-supported vestibular and balance progressions (Headway; Physio-Pedia). Physiopedia+3Illinois CMS+3Flint Rehab+3

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Helpful tools, apps, and “real-life” activities

• App-based brain training & aids: curated lists of neurorehab apps (NHS-cited roundup) and brain-injury-specific app guides can support attention, memory, and executive function. krysalisconsultancy.co.uk+1

• Home activities list: simple ideas (breathing practice, yoga/Tai Chi, crafts) that mix sensory, cognitive, and gentle motor work—useful on lower-energy days. krysalisconsultancy.co.uk

• Video libraries: many clinics share vestibular, balance, breathing, and vision drills with safety disclaimers you can follow at home between visits. Toronto Concussion Clinic

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Where Integrative Chiropractic Care fits

Integrative chiropractic combines spinal/joint care with functional neurology, vestibular drills, posture work, and lifestyle coaching. In a TBI plan, this team can help with:

1. Neck-driven headaches and dizziness – gentle cervical, thoracic, and rib care plus cervical stabilization and gaze stabilization drills to reduce triggers. Dr. Alexander Jimenez often pairs spine work with vestibular and sensory-motor retraining, posture/breathing, and graded activity—especially for patients whose symptoms flare with neck strain or visual load. El Paso, TX Doctor Of Chiropractic+1

2. Alignment & movement mechanics – adjustments and soft-tissue techniques may improve segmental motion and reduce nociceptive input, making exercise practice more comfortable. Some programs explicitly blend chiropractic with physical therapy to speed functional gains after accidents. Georgia Spine & Orthopaedics

3. Functional-neurology style rehab – targeted sensory inputs (eye movements, balance progressions, dual-task walking) to drive neuroplastic change. Clinics describe this approach as non-invasive, exercise-centric, and personalized. HML Functional Care+1

4. Lifestyle & pacing – sleep, stress tools (breathing), graded screen time, and safe return-to-work tips, often delivered as part of the visit or home plan (consistent with concussion recovery guidance). Concussion Alliance

About craniosacral therapy: Some chiropractors and integrative clinics offer craniosacral techniques. Supporters suggest it can ease tension and support cerebrospinal fluid (CSF) dynamics); evidence is mixed and more high-quality trials are needed. If you’re interested, discuss risks/benefits and choose qualified providers. zakerchiropractic.com+2Healthline+2

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Five common rehab combinations (and why they work)

1. Cardio + Cognitive: 10–20 minutes of easy cycling or walking before attention/memory drills can improve focus. cognitivefxusa.com

2. Neck care and vestibular care, including cervical mobilization/stabilization, followed by gaze stability, often reduce dizziness more effectively than either approach alone, according to many integrative clinic protocols. El Paso, TX Doctor Of Chiropractic

3. Balance and eye tracking: Tandem stance or staggered stance with smooth pursuit (following your finger) builds visual-vestibular coordination. Flint Rehab

4. Strength + Dual-task: light squats or carries while counting backward or naming categories—safe cognitive loading during movement. (Concept aligns with neuroplasticity practice). Flint Rehab

5. Yoga/Tai Chi + Breathwork: Gentle sequences enhance mobility and alleviate autonomic symptoms, often recommended for veterans and individuals with stress-related conditions. krysalisconsultancy.co.uk+1

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Reducing dizziness: a mini-progression you can try (with support)

Level 1: Seated gaze stabilization (target at arm’s length), 3×20–30 seconds each direction.
Level 2: Standing feet together, same gaze drill, 3×20–30 seconds.
Level 3: Tandem stance + gaze drill, 3×20–30 seconds.
Level 4: Tandem walking heel-to-toe, 2×20 feet.
Level 5: Add head turns every 2–3 steps (only if safe).
This follows common vestibular/balance progressions from national brain-injury groups and patient handouts. headway.org.uk+1

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Cognitive workout menu (10–20 minutes/day)

• New experiences: Try a small new skill (chopsticks, a new recipe, left-hand writing) to increase novelty and engage multiple networks (patient-education sources). Great Speech

• Brain apps: choose 1–2 tasks aligned with your goals (e.g., attention or working memory). Avoid marathon sessions; short and consistent wins. Flint Rehab+1

• Real-life problem-solving: plan a grocery list under time pressure; estimate costs; map the route. (Supports executive function and sequencing.) Flint Rehab

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What about intensity and timing?

• First 24–48 hours (concussion): “relative rest,” light walking if it doesn’t worsen symptoms; avoid long screen time early. Concussion Alliance

• After day 2–3: graded aerobic + simple strength/balance as tolerated.

• Weeks 1–4: progress duration first, then difficulty; layer vestibular and cognitive drills.

• Beyond 1 month, many will edge toward public health activity goals (with therapy input), still using symptom-guided pacing. Physiopedia

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When to call your clinician

• Symptoms jump >2 points and don’t settle within an hour.

• Falls, fainting, or new neurologic signs (weakness, speech changes).

• Worsening neck pain or visual problems.

• You’re unsure about how to proceed with the plan safely.

Vestibular, physical, occupational, speech-language, and cognitive rehabilitation specialists, as well as integrative chiropractic/functional neurology clinics, can tailor plans to your specific goals and medical needs. Neural Effects+1

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Dr. Alexander Jimenez’s clinical notes (integrative perspective)

• Neck-driven symptoms (headache, dizziness, visual strain) often improve when cervical mechanics and posture are addressed alongside vestibular and sensory-motor drills.

• Breathing mechanics and thoracic mobility help reduce upper-quarter tension, which can amplify head/neck symptoms.

• Graded return-to-readiness: light aerobic work, then short “cog” blocks; track triggers; adjust screen time; protect sleep.

• Team-based care matters—PT/OT/SLP, primary care/neurology, and legal/return-to-work supports when needed.
  (Embedded in Dr. Jimenez’s recent patient-education pages on TBI, posture, and hidden symptoms.) El Paso, TX Doctor Of Chiropractic+1

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Frequently asked questions

Q: Is “pushing through” dizziness a good idea?
A: No. The goal is symptom-limited exposure—mild increases during a drill that settle quickly are okay; spikes that linger are a sign to scale back and rebuild. Physiopedia

Q: Can I lift weights?
A: Yes, but start with body-weight and light bands; keep breathing; avoid breath-holding (Valsalva). Add load gradually and prioritize form. Common home TBI programs include simple, safe progressions. Illinois CMS+1

Q: Do brain-training apps work?
A: They can help when they are targeted to your goals, used consistently, and combined with real-life tasks (planning, chores, social games). Mix digital and analog tools. krysalisconsultancy.co.uk+1

Q: Should everyone do craniosacral therapy?
A: It’s optional. Some patients report relief, but the evidence is mixed. Discuss it with your clinician and focus first on core rehab (aerobic, strength, balance/vestibular, cognitive, and neck/posture care). Healthline+1

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Putting it all together

Think of TBI rehab as layers:

1. Move (light cardio most days).

2. Strengthen (2–3x/week basics).

3. Balance & vestibular (daily short sets).

4. Cognition (10–20 minutes daily, targeted).

5. Neck/posture/breath (little bits often).

6. Integrative support (chiropractic + functional neurology with PT/OT/SLP as needed).

With patient-friendly tools, graded exposure, and a team mindset, most people experience steady improvements—less dizziness, better focus, stronger legs, and increased confidence.

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References

• American Physical Therapy Association—Neurology Section. (n.d.). Exercise after traumatic brain injury (Fact Sheet). NeuroPT. https://www.neuropt.org/ neuropt.org+1

• bpacnz. (2022, April 26). An overview of concussion/mild traumatic brain injury. https://bpac.org.nz/2022/concussion.aspx Best Practice Advocacy Centre

• Concussion Alliance. (n.d.). Recovery guide: Relative rest and early activity. https://www.concussionalliance.org/recovery-guide Concussion Alliance

• Cognitive FX. (2024, July 16). 17 cognitive exercises for post-concussion syndrome. https://www.cognitivefxusa.com/blog/cognitive-exercises-for-post-concussion-syndrome cognitivefxusa.com

• Dr. Alex Jimenez. (2025, Oct.). Traumatic brain injury and posture: Signs and solutions; Finding hidden TBI symptoms: Signs you might miss. https://dralexjimenez.com/ El Paso, TX Doctor Of Chiropractic+1

• Flint Rehab. (2022, Sept. 21). Traumatic brain injury recovery exercises: Full-body & cognitive TBI exercises to try at home. https://www.flintrehab.com/exercises-for-brain-injury-recovery/ Flint Rehab

• Flint Rehab. (2023, Nov. 14). Balance exercises for brain injury patients of all levels. https://www.flintrehab.com/balance-exercises-for-brain-injury-patients/ Flint Rehab

• Flint Rehab. (2025, Feb. 28). Neuroplasticity exercises after stroke: 10 strategies for recovery (neuroplasticity overview parallels TBI rehab). https://www.flintrehab.com/neuroplasticity-exercises-after-stroke/ Flint Rehab

• Flint Rehab. (2025, Mar. 17). Neuroplasticity exercises for brain injury. https://www.flintrehab.com/neuroplasticity-exercises-for-brain-injury/ Flint Rehab

• Great Speech. (2020, Aug. 1). 10 cognitive exercises to help recover from traumatic brain injury. https://www.greatspeech.com/10-cognitive-exercises-to-help-recover-from-traumatic-brain-injury/ Great Speech

• Headway UK. (2016, Nov. 23). Struggling with balance problems after brain injury? 12 exercises to help. https://www.headway.org.uk/news-and-campaigns/news/struggling-with-balance-problems-after-brain-injury-try-these-12-exercises-to-help/ headway.org.uk

• HML Functional Care. (2025, Jul. 22). How chiropractic neurology supports brain healing; Treatments: Functional neurology. https://hmlfunctionalcare.com/ HML Functional Care+1

• Illinois CMS. (n.d.). Traumatic brain injury recovery: At-home exercises. https://cms.illinois.gov/benefits/stateemployee/bewell/getmoving/traumatic-brain-injury-recovery.html Illinois CMS

• Krysalis Consultancy. (n.d.). Over 200 home activities for brain injury survivors & families; Twenty apps to boost brain injury rehabilitation. https://www.krysalisconsultancy.co.uk/ krysalisconsultancy.co.uk+1

• Physio-Pedia. (n.d.). Physical activity guidelines for traumatic brain injury; Post-concussion syndrome (Vestibular rehab). https://www.physio-pedia.com/ Physiopedia+1

• Toronto Concussion Clinic. (n.d.). Concussion rehab exercise video library. https://torontoconcussion.ca/concussion-rehab-video-series/ Toronto Concussion Clinic

• Zaker Chiropractic. (2025). Chiropractic care for head injury rehabilitation (craniosacral description). https://zakerchiropractic.com/chiropractic-care-head-injury-rehabilitation/ zakerchiropractic.com

• Healthline. (2024, Aug. 29). Cranial sacral therapy: Benefits and side effects (evidence overview). https://www.healthline.com/health/cranial-sacral-therapy Healthline

• Georgia Spine & Orthopaedics. (2025, Jan. 17). Combining chiropractic and physical therapy. https://www.gaspineortho.com/combining-chiropractic-and-physical-therapy/ Georgia Spine & Orthopaedics

• Verywell Mind. (2020). Yoga, Tai Chi, and meditation provide relief for veterans (support for complementary practices). https://www.verywellmind.com/ Verywell Mind

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, and physical medicine, as well as wellness, sensitive health issues, and functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and the jurisdiction in which they are licensed to practice. We utilize functional health and wellness protocols to treat and support care for musculoskeletal injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters and issues that directly or indirectly support our clinical scope of practice. Our office has made a reasonable effort to provide supportive citations and to identify relevant research studies that support our posts. We provide copies of supporting research studies upon request to regulatory boards and the public.

We understand that we cover matters that require an additional explanation of how they may assist in a particular care plan or treatment protocol. To discuss the subject matter above further, please contact Dr. Alex Jimenez or us at 915-50-0900.

Dr. Alex Jimenez, DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

Email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*