TBI & Head Injury Rehab: Exercises for Recovery

TBI & Head Injury Rehab: A Practical, Step-By-Step Exercise Guide for Aerobic, Strength, Balance, and Brain Training

Why exercise is central after a TBI or head injury

After a traumatic brain injury (TBI) or head injury, people often struggle with energy, strength, balance, attention, and memory. A well-built rehab plan blends aerobic activity, strength training, balance/vestibular drills, and cognitive exercises. This mix trains the body and brain together by utilizing neuroplasticity—the brain’s ability to form new connections through targeted, repetitive practice (Flint Rehab, 2025). Research and clinical guidelines also indicate that exercise improves mood, sleep, and daily functioning (Neuro PT/APTA, n.d.; Physio-Pedia, n.d.). flintrehab.com+2neuropt.org+2

Key idea: Move safely, progress slowly, and keep sessions short but consistent. Over time, you rebuild endurance, strength, balance, and thinking skills together.

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Safety first: how to start without setbacks

Before you begin:

• Medical clearance: Get evaluated for red flags like worsening headache, repeated vomiting, fainting, new weakness, or neck pain after trauma.

• Baseline symptoms: Rate dizziness, headache, fatigue, and brain fog (0–10). Stop or modify when symptoms increase by more than 2 points and resolve with hydration and rest.

• Pick low-impact modes first: Walking, light stationary cycling, or gentle elliptical are common first steps (Neuro PT/APTA, n.d.). neuropt.org

General dose targets (adjust to your level):
Guidelines commonly recommend 150 minutes/week of moderate cardio or 75 minutes of vigorous exercise, plus strength, flexibility, and balance work spread throughout the week (Physio-Pedia, n.d.). If you’re early in recovery, you’ll ramp up in small steps, not jump straight to these numbers. physio-pedia.com

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The four pillars of a head-injury exercise plan

1) Aerobic training: rebuild stamina and regulate the nervous system

Why it matters: Cardio supports blood flow, energy systems, and cognitive endurance. It can also reduce anxiety and improve sleep.

Starter choices (10–20 minutes to begin):

• Walk-and-talk: Easy walk where you can speak in full sentences.

• Stationary bike: Smooth cadence, low resistance; try intervals like 2 minutes easy / 1 minute slightly harder.

• Elliptical or water walking: Low load on joints; gentle rhythm helps balance (Neuro PT/APTA, n.d.). neuropt.org

Progression tips:

• Add 1–3 minutes per session or bump intensity slightly when symptoms stay stable during and 24 hours after the workout.

• Many programs place light cardio before cognitive training to “prime” attention and focus (Cognitive FX, 2024). cognitivefxusa.com

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2) Strength training: legs, core, and pulling patterns first

Why it matters: Strength restores joint stability, spinal support, and confidence in movement. Lower-body and core strength improve gait and balance; rows help posture and neck comfort.

Begin with body-weight basics (2–3 sets of 6–10 reps):

• Sit-to-stand or box squats

• Supported split squats

• Hip hinge with dowel (practice spine alignment)

• Wall rows or band rows (posture and scapular control)

• Dead bug or bird dog (core bracing and cross-body control)

Start with a slow tempo, exhale on effort, and take long rests. Over time, add mini-bands or light dumbbells. Strength training is recommended in conjunction with aerobic exercise, flexibility, and balance for individuals with a history of TBI (Physio-Pedia, n.d.). physio-pedia.com

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3) Balance & vestibular drills: steady your stance, vision, and inner ear

Why it matters: Dizziness, swaying, and visual motion sensitivity are common after head injuries—even mild ones (Headway, 2024). Specific drills retrain the vestibular and visual systems, reducing fall risk. headway.org.uk

Progression ideas (hold 20–30 seconds, 3–5 reps, daily as tolerated):

• Static foundations:

  • Feet together → half-tandem → tandem (heel-to-toe) → single-leg

  • Perform near a countertop for safety.

• Surface progressions:

  • Firm ground → foam pad → grass.

• Vision progressions:

  • Eyes open → eyes closed → head turns.

• Gaze stabilization (VOR):

  • Keep your eyes fixed on a letter on the wall; turn your head left/right, or up/down, at a comfortable speed while keeping the letter clear.

• Dynamic balance:

  • Tandem walk on a line, cone taps, side steps, and march & hold.

Community resources also suggest that yoga, Pilates, Tai Chi, and flexibility exercises can support balance and body awareness (Headway, 2016). headway.org.uk

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4) Cognitive training: wake up attention, memory, and speed

Why it matters: Many people feel “slowed down” or easily overwhelmed. Cognitive tasks can be incorporated into workouts or performed as brief “brain sets.”

Options to mix in:

• New learning & novelty: Learn a simple song on piano, a few phrases in a new language, or a basic cooking recipe (Great Speech, 2020).

• Paper-and-pencil / apps: Word lists, category naming, trail-making, N-back, or reputable brain-training apps (Flint Rehab, 2022; Great Speech, 2020).

• Use your non-dominant hand for daily tasks to challenge motor planning (Great Speech, 2020; Flint Rehab, 2022).

• Dual-task training: Walk while sorting playing cards by color, or do gentle step-ups while answering simple math (BIAMD, 2019). Great Speech+2flintrehab.com+2

Short, frequent bouts (5–15 minutes) usually beat long, draining sessions. Increase difficulty gradually (Concussion Care NZ, 2025). concussioncare.co.nz

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How neuroplasticity ties it all together

Repeated, task-specific practice tells the brain, “This matters—keep this pathway.” That’s neuroplasticity. When you practice coordinated movements, gaze control, and problem-solving together, you strengthen the neural pathways that support daily life (Flint Rehab, 2025). flintrehab.com

Simple formula:
Specific task + enough repetitions + small progressions + adequate rest = better brain-and-body function

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A phased plan you can adapt

Phase 1: Settle symptoms, learn the basics (days to weeks)

• Aerobic: 10–15 minutes easy walk or bike, most days.

• Strength: 2 days/week of sit-to-stand, wall rows, and core bracing (2–3 sets).

• Balance: Feet together → half-tandem; basic VOR at slow speed.

• Cognitive: 5–10 minutes of attention tasks (lists, matching) after cardio.

• Rule: Stop if symptoms increase by>2 points; resume when baseline is reached.

Phase 2: Build capacity (weeks to months)

• Aerobic: 20–30 minutes, with small intervals added.

• Strength: 2–3 days/week; add light resistance and hinge/split-squat progressions.

• Balance: Tandem stance/walk, foam surface, head turns with gaze stabilization.

• Cognitive: Dual-task practice 10–15 minutes; introduce timed tasks.

Phase 3: Return to demanding life & sport (individualized timeline)

• Aerobic: 30–40 minutes, sport-or job-specific intervals.

• Strength: Heavier resistance; add unilateral and power-timing drills as safe.

• Balance: Reactive drills (catch/throw), uneven surfaces, faster head movements.

• Cognitive: Multi-step planning, memory under mild physical stress (e.g., obstacle walks while recalling a list).

These ideas align with public resources for home exercise progressions and clinical guidance for people with head injuries (Flint Rehab, 2022; Neuro PT/APTA, n.d.; Physio-Pedia, n.d.). flintrehab.com+2neuropt.org+2

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At-home equipment that helps

• Mini-bands and light dumbbells for progression.

• Foam pad or folded yoga mat for stance work.

• Metronome app to pace steps or eye-head drills.

• Sticky note/letter target for gaze stabilization.

• Notebook to track reps, symptoms, and wins.

The head-injury community lists also include creative, low-cost options, such as chess, large-piece puzzles, and focused breathing, to challenge attention and coordination (Krysalis, n.d.). krysalisconsultancy.co.uk

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Sample 2-week starter plan (adapt to your level)

Rule of thumb: 20–40 total minutes per day, broken into small blocks. If symptoms rise, scale back duration or complexity.

Week 1 (Mon/Wed/Fri):

• Cardio walk 12–15 min (easy).

• Strength circuit x2: sit-to-stand 8, wall rows 10, dead bug 6/side.

• Balance: half-tandem 20 sec × 3, gaze stabilization 30 sec × 3.

• Cognitive: 7 minutes of word lists or category naming.

Week 1 (Tue/Thu/Sat):

• Stationary bike 12–15 min (easy).

• Balance line walk 5 lengths; cone taps 10 times per side.

• Cognitive dual task: slow marching while reciting months backward (3–5 min).

Week 2—progress slightly:

• Add 2–3 minutes of cardio, 1 set of strength training, and advance to a tandem stance or tandem walk if safe.

• Try one simple interval day: 2 minutes easy / 30 seconds moderate × 6–8.

These home-style ideas mirror widely shared TBI exercise lists and progressions (Flint Rehab, 2022; Neuro PT/APTA, n.d.). flintrehab.com+1

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Coordination & dual-task drills: bridge body and brain

• Step matrix: Step to colored floor markers in a sequence, then in reverse.

• Reach matrix: From a half-tandem stance, reach to numbered targets on a wall.

• Card sort walk: Walk a hallway while sorting cards by suit, then value (BIAMD, 2019). BRAIN INJURY ASSOCIATION OF MARYLAND

These drills combine movement, attention, and planning—key for daily multitasking after a head injury.

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Cognitive exercise menu you can rotate

• Attention: Trail-making worksheets, “find the difference,” or timed word search.

• Working memory: 3- to 5-item number spans; recall a short grocery list while you walk.

• Executive skills: Plan a short recipe, schedule a morning routine, or budget a simple trip (Great Speech, 2020).

• Processing speed: Timed matching or mental math sprints.

• Novelty & non-dominant hand: Brush teeth, eat, or write a short note with your non-dominant hand (Great Speech, 2020; Flint Rehab, 2022; Concussion Care NZ, 2025). Great Speech+2flintrehab.com+2

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Managing dizziness and visual motion

For many, gaze stabilization (VOR) plus gradual exposure to busy environments works best. Begin in a quiet space, then progress to mild background motion (e.g., a slow ceiling fan), and finally, move to a store aisle for a brief visit. Headway offers community-friendly balance tips and vestibular strategies (Headway, 2016; 2024). Vestibular rehab is often part of a comprehensive plan (Headway, 2016). headway.org.uk+1

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How integrative chiropractic care can fit into TBI rehab

What it can address:

• Neck and spine mechanics: Gentle manual care and mobility exercises may help alleviate neck-related headaches and reduce motion sensitivity, thereby supporting improved exercise tolerance.

• Autonomic balance & sensorimotor input: Some chiropractors incorporate functional neurology drills, eye-head coordination work, and graded sensory input alongside home exercise progressions (HML Functional Care, 2025).

• Craniosacral therapy: Some clinics report using gentle craniosacral methods aimed at reducing tension and supporting cerebrospinal fluid flow. Evidence is evolving, and this approach should be used as part of an individualized, clinician-guided plan (Zaker Chiropractic, 2025). HML Functional Care+1

In Dr. Alexander Jimenez’s dual-scope model (DC + APRN):
Dr. Jimenez emphasizes the importance of thorough history-taking to identify hidden symptoms, a step-wise return to activity, and combining spinal care with targeted exercise, nutrition, and medical oversight when necessary (Jimenez, 2025a; 2025b; 2025c). This approach supports the nervous system as patients progress through the layers of rehabilitation, including aerobic, strength, balance, and cognitive components. El Paso, TX Doctor Of Chiropractic+2El Paso, TX Doctor Of Chiropractic+2

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Putting it all together: a weekly structure (example)

Mon – Cardio 20 min easy + Strength A (squat/row/core) + Gaze stabilization
Tue – Cardio 15–25 min intervals + Balance progressions + Cognitive app 10 min
Wed – Recovery walk 15–20 min + Mobility/yoga 15 min + Non-dominant-hand tasks
Thu – Cardio 25–30 min steady + Strength B (split squat/hinge/press) + Dual task
Fri – Cardio 20 min easy + VOR + Tandem walk + Memory games 10 min
Sat – Outdoor activity (park loop, pool walking) + Light circuits
Sun – Restorative day: breathing, stretching, low-stimulus hobbies

This balanced schedule reflects common physical activity guidance for people with head injuries, adapted to individual tolerance (Physio-Pedia, n.d.; Neuro PT/APTA, n.d.). physio-pedia.com+1

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Troubleshooting common roadblocks

• “My symptoms spike during workouts.”
  Reduce the intensity by one level, shorten the session, or switch the order (e.g., do balance exercises before strength exercises). Keep hydration and cool airflow.

• “I feel off balance in stores.”
  Practice gaze stabilization and short, graded exposures. Start with a single aisle for 2–3 minutes.

• “Cognitive work wipes me out.”
  Try cardio first, then short (5–10 minute) brain blocks with longer rest (Cognitive FX, 2024). cognitivefxusa.com

• “I’m overwhelmed by choices.”
  Follow the sample plan, log your sessions, and progress one variable at a time.

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When to pause and call your clinician

• Worsening severe headache, repeated vomiting, fainting, new numbness/weakness, chest pain, or sudden vision changes.

• A fall or head hit that changes your baseline.

• Any concern that feels different from your usual symptoms.

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What progress often looks like (weeks to months)

• More steps and longer walks without symptom spikes.

• Better stance times (tandem, single-leg), smoother head turns while reading a sign.

• Stronger lifts with stable form and normal breathing.

• Faster recovery after cognitive tasks.

• Improved daily function: cooking without fatigue, shopping with less dizziness, steadier workdays.

Remember: gains may be non-linear. Small, regular practice beats rare, heroic efforts. Neuroplastic change takes repetition and time (Flint Rehab, 2025). flintrehab.com

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Extra resources you can use today

• Home exercise menus for TBI: Step-by-step examples for legs, core, arms, balance, and cognition (Flint Rehab, 2022). flintrehab.com

• Balance & vestibular guides: Practical tips and exercise ideas from brain-injury organizations (Headway, 2016; 2024). headway.org.uk+1

• Activity lists for at-home brain challenges: 200+ ideas including breathing, yoga/Tai Chi, and coordination games (Krysalis, n.d.). krysalisconsultancy.co.uk

• Clinical guidance: Exercise after TBI fact sheet from the APTA Neurology Section and physical-activity summaries (Neuro PT/APTA, n.d.; Physio-Pedia, n.d.). neuropt.org+1

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Final word

Recovery from a traumatic brain injury (TBI) or head injury is not a linear process. The best plans keep aerobic, strength, balance, and cognitive work moving forward together—slowly, steadily, and safely. Add integrative support when appropriate (including chiropractic and functional neurology methods) to manage neck pain, headaches, dizziness, and sensorimotor control issues while you build capacity. Most of all, track your efforts, celebrate small wins, and keep going. Your consistency drives neuroplastic change.

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References

• American Physical Therapy Association – Neurology Section. (n.d.). Exercise after traumatic brain injury (fact sheet). https://www.neuropt.org/docs/default-source/brain-injury-sig/bi-sig/exercise_after_tbi.pdf neuropt.org

• BIAMD. (2019). Dual tasking and brain injury (slides). https://www.biamd.org/uploads/8/5/7/7/85779996/doran_-_dual_tasking_and_brain_injury.pdf BRAIN INJURY ASSOCIATION OF MARYLAND

• 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

• Concussion Care New Zealand. (2025, July 18). Cognitive exercises for concussion recovery. https://www.concussioncare.co.nz/resources/cognitive-exercises-for-concussion-recovery concussioncare.co.nz

• Flint Rehab. (2022, Sept 21). Traumatic brain injury recovery exercises: 20 best TBI exercises. https://www.flintrehab.com/exercises-for-brain-injury-recovery/ flintrehab.com

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

• Flint Rehab. (2025, Feb 20). Neuroplasticity exercises for brain injury. https://www.flintrehab.com/neuroplasticity-exercises-for-brain-injury/ flintrehab.com

• 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. (2016, Nov 23). Struggling with balance problems after brain injury? Try these 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

• Headway. (2024). Balance problems and dizziness after brain injury (publication). https://www.headway.org.uk/media/12019/balance-problems-and-dizziness-after-brain-injury-publication.pdf headway.org.uk

• HML Functional Care. (2025, July 22). How chiropractic neurology supports brain healing. https://hmlfunctionalcare.com/how-chiropractic-neurology-supports-brain-healing/ HML Functional Care

• Jimenez, A. (2025a). Finding hidden TBI symptoms: Signs you might miss. https://dralexjimenez.com/finding-hidden-tbi-symptoms-signs-you-might-miss/ El Paso, TX Doctor Of Chiropractic

• Jimenez, A. (2025b). Traumatic brain injury: Understanding the long-term effects. https://dralexjimenez.com/traumatic-brain-injury-understanding-the-long-term-effects/ El Paso, TX Doctor Of Chiropractic

• Jimenez, A. (2025c). Traumatic brain injury and posture: Signs and solutions. https://dralexjimenez.com/traumatic-brain-injury-and-posture-signs-and-solutions/ El Paso, TX Doctor Of Chiropractic

• Krysalis Consultancy. (n.d.). Over 200 home activities for brain injury survivors. https://www.krysalisconsultancy.co.uk/resources/item/over-200-home-activities-for-brain-injury-survivors krysalisconsultancy.co.uk

• Physio-Pedia. (n.d.). Physical activity guidelines for traumatic brain injury. https://www.physio-pedia.com/Physical_Activity_Guidelines_for_Traumatic_Brain_Injury physio-pedia.com

• Physio-Pedia. (n.d.). Physical activity guidelines for TBI (ACSM summary excerpt). https://www.physio-pedia.com/Physical_Activity_Guidelines_for_Traumatic_Brain_Injury?veaction=edit physio-pedia.com

• Upstate PM&R. (2014). Exercise and traumatic brain injury (literature summary). https://www.upstate.edu/pmr/pdf/ward.pdf Upstate Medical University

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