Rehabilitation Exercises for Head Injuries: A Practical, Whole-Body Plan for Aerobic, Strength, Balance, and Cognitive Training (with Integrative Chiropractic Support)

Why exercise is central after a head injury

After a head injury, the body and brain heal best when you move on purpose, and with a plan. Exercise supports mood, attention, cardio fitness, strength, and balance. Carefully dosed activity has been shown to improve cognition and physical function in people after TBI, with typical recommendations of 20–40 minutes of rhythmic aerobic exercise, 3–4 days per week, scaled to the individual’s abilities. Neuropt

International rehab resources also outline a multicomponent program: cardiovascular exercise for endurance, strength training for muscles and posture, balance training to reduce falls and dizziness, flexibility for range of motion, and cognitive training to rebuild thinking skills. Physiopedia

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The rehab “engine”: neuroplasticity, repetition, and progression

Your nervous system can rewire through neuroplasticity—the brain’s ability to strengthen or reroute connections. Repeated, task-specific practice drives these changes. In simple terms: pick the skill you want to improve, practice it often, and make it a little harder over time. CMS Illinois+2flintrehab.com+2

How to use this principle in daily training

• Repetition: Short, frequent practice beats rare, long sessions.

• Specificity: Work directly on targeted abilities (e.g., gait, hand dexterity, memory).

• Progression: Add small challenges (speed, surface, dual-tasking) as tolerated.

• Feedback: Track reps, time, difficulty, and symptoms. (See the sample tracker near the end.)

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Safety first

• Medical clearance is important if you have red flags (worsening headaches, repeated vomiting, fainting, severe neck pain, new weakness, seizures, chest pain).

• Start below your symptom threshold and build gradually. If symptoms spike during or after a session, reduce the intensity or duration of the next session.

• Consider home-based options and caregiver supervision when transportation or safety is a barrier. Neuropt

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Aerobic training: rebuild endurance and regulate the nervous system

Goal: Improve heart-lung fitness, energy levels, mood, and attention.

Starter options (pick one):

• Walking (treadmill or outdoors), stationary cycling, or elliptical, beginning with 5–10 minutes and progressing toward 20–40 minutes per session, 3–4x/week. Keep the effort moderate and pause if symptoms worsen. Neuropt+1

Progressions:

• Add intervals (e.g., 2 minutes easy, 1 minute slightly harder).

• Vary terrain for gentle challenge (flat ? slight incline).

• Combine walking and cognitive tasks (e.g., naming categories while you walk).

At-home seated starters when standing is hard:

• Seated marching, heel–toe raises, or weight shifts to awaken core and legs. String short bouts together and build total minutes across the day. CMS Illinois

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Strength training: restore power, posture, and confidence

Why it matters: Strong legs and trunk improve walking, transfers, and balance. Strength work also supports neck and shoulder mechanics that often get tight or painful after whiplash or falls.

Foundational moves (2–3 sets of 6–12 reps, 2–3x/week):

• Sit-to-stand or supported squats (use a chair for support).

• Hip hinges (bowing pattern) and bridges for glutes.

• Rows with a band to open the chest and stabilize the shoulder blades.

• Wall push-ups progressing to incline push-ups.

• Step-ups to a low step, holding a rail.

• Core bracing (gentle abdominal set) paired with breathing.

Tailor volume to symptoms and quality of movement. Even low-resistance, rhythmic movements can help when heavier loads feel too intense early on. Neuropt+1

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Balance & equilibrium training: steady the ground under you

Dizziness and unsteadiness are common after head injuries, especially when the vestibular system is involved. Vestibular rehabilitation (VR) is an exercise-based approach that uses head, eye, neck, and body movements—under varied visual backgrounds—to improve gaze stability, motion tolerance, and balance. Programs include habituation (becoming accustomed to motion), gaze stabilization (VOR drills), static and dynamic balance exercises, and walking tasks. PMC+2PMC+2

Static balance (start near a counter for safety):

• Feet together ? semi-tandem ? tandem stance (heel-to-toe) ? single-leg stance. Hold for 10–30 seconds, rest, and repeat 3–5 times. Progress by closing eyes or adding gentle head turns once the basic stance is steady. flintrehab.com

Dynamic balance:

• Heel-to-toe walking along a line.

• Head turns while walking (look left–right or up–down).

• Obstacle steps (cones, books) to train foot clearance. flintrehab.com

Gaze-stability drill (VOR x1):

• Hold a target (e.g., sticky note) at arm’s length. Move your head left to right while keeping your eyes on the target for 10–30 seconds; repeat up and down. Start small and slow; increase range and speed as symptoms allow. PMC+1

Why this works: With practice, the brain “rebalances” signals from the inner ears, joints, and eyes—called vestibular compensation—and dizziness tends to fade. headway.org.uk+1

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Coordination & dual-task training: move and think at once

Real life asks you to walk while talking, turn while carrying, or scan the room while stepping around a pet. Train this safely:

• Dual-task walking: Walk and recite every other letter, list fruits, or count by 3s.

• Target taps: Place sticky notes at shoulder height and tap left and right in a pattern.

• Metronome steps: Step to a beat (helps timing and rhythm).

Start simple, then make the cognitive piece slightly harder (e.g., from naming colors ? naming animals that start with “B”). Build accuracy before speed.

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Cognitive training: rebuild attention, memory, speed, and flexibility

Cognitive exercises can be easily integrated into daily routines and are a key pillar of TBI rehabilitation. Helpful formats include attention drills, memory strategies, executive-function tasks, and language practice, with steady progression. flintrehab.com+1

Everyday cognitive builders (easy starters):

• Use your non-dominant hand occasionally (e.g., brushing your teeth, opening doors, simple writing). It presents a novel motor-cognitive challenge that sparks the formation of new neural patterns. zaorehab.com+1

• Spaced retrieval (practice recalling a fact at increasing time gaps).

• Journaling or creative writing to improve organization and memory.

• Board or puzzle games (e.g., chess, word games, matching) for strategy and problem-solving. krysalisconsultancy.co.uk

• Brain-training apps (visual scanning, working memory, processing speed). Choose short modules and track your scores over time. flintrehab.com

Speech-language targets (if language or speech is affected):

• Syllable practice (“ba–pa–ma”), slowed, clear speech, and simple reading aloud, performed often across the day to drive neuroplastic changes. Great Speech+1

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Flexibility & mobility: keep the system moving

Stiffness in the neck, chest, low back, and hips can worsen headaches, restrict breathing, and reduce balance control.

• Neck range-of-motion (gentle nods and rotations within pain-free limits).

• Thoracic openers (supine “snow angels” or doorway pec stretch).

• Hip flexor and calf stretches to support stride and ankle balance strategies.

• Yoga or tai chi variants for slow, controlled motion and breath. Neuropt

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A clinic-tested weekly template (scale to your level)

Aim: 5–6 training days/week, mixing systems. Keep sessions 20–45 minutes unless advised otherwise.

Day 1 – Aerobic + Core

• 10–30 min walking or cycling (easy–moderate).

• Core bracing 3×8; bridges 3×10; rows 3×10.

Day 2 – Balance + Cognitive

• Static stances (feet together ? tandem ? single-leg) 3–5 rounds of 15–30 sec each.

• Gaze-stability VOR x1 (10–20 sec bouts).

• Dual-task walking: 5 minutes (name items in a category). PMC

Day 3 – Strength

• Sit-to-stand 3×8, step-ups 3×8/leg, wall push-ups 3×8, and band rows 3×10.

Day 4 – Aerobic Intervals + Flexibility

• 2:1 walk intervals for 15–25 minutes; neck/pec/calf stretches for 30–45 seconds each.

Day 5 – Vestibular & Coordination

• Heel-to-toe walking (2–3 passes).

• Head-turn walking (in a slow, safe environment).

• Target taps and metronome stepping (2–3 minutes). flintrehab.com

Day 6 – Cognitive Focus

• 20–30 minutes total: journaling, spaced retrieval, language drills, and 1–2 brain-app modules. Include one non-dominant-hand task. flintrehab.com+1

Day 7 – Restorative

• Gentle yoga or tai chi, mindful breathing, and a light walk.

Symptom rule: If dizziness, headache, or fatigue jump during a session, pause, hydrate, breathe, and resume later at a lower difficulty. Track triggers and wins.

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Home-based options when mobility is limited

If standing is hard or transportation is a challenge, build a home circuit from seated drills and short bouts through the day:

• Seated hip internal/external rotation, abduction/adduction, marching, trunk side bends, trunk extensions, heel–toe raises, and weight shifts—all great “activation” moves. Combine these with cognitive games and journaling to create a mini-session that you can repeat in the morning, midday, and evening. CMS Illinois

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Integrative chiropractic therapy: supporting symptoms and training tolerance

How it helps the plan: An integrative chiropractic approach can complement your exercise program by addressing neck and upper back mechanics, headache triggers, and dizziness that often follow head injuries. Restoring cervical motion, reducing muscle tone, and improving posture can make aerobic and balance sessions more tolerable, which indirectly supports neuroplasticity by allowing more frequent, high-quality practice. Many chiropractors also prescribe home exercises and coach patients on lifestyle habits (such as sleep, stress, and hydration) that influence recovery. El Paso, TX Doctor Of Chiropractic

For dizziness specifically: Some clinics incorporate elements consistent with vestibular rehabilitation (e.g., gaze-stability work, balance progressions) and may coordinate with PT/OT and SLP for a cohesive plan. Evidence reviews describe vestibular therapy as exercise-based, focusing on adaptation, substitution, balance, and gait to reduce dizziness and improve function after concussion. PMC+1

Craniosacral therapy (CST): Certain providers use CST—a gentle hands-on technique aimed at easing fascial tension and improving cerebrospinal fluid dynamics—to help headache or pressure complaints. While clinical claims vary, some chiropractic and rehab clinics report patient-perceived benefits as part of a multimodal plan. Discuss risks and expected outcomes with your clinician, and integrate CST only as an adjunct to your active program. zakerchiropractic.com

Dr. Alexander Jimenez, DC, APRN, FNP-BC highlights a dual-scope, integrative model that blends musculoskeletal care with medical assessment, exercise prescription, and collaboration with rehab professionals—useful for complex cases with neck pain, migraines, dizziness, and postural issues after car crashes or sports injuries. El Paso, TX Doctor Of Chiropractic

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Coaching tips that make the difference

• Start slow, but start. Early, gentle activity helps prevent deconditioning and boosts motivation. flintrehab.com

• Short bursts add up. Two or three 10-minute sessions can equal one 30-minute session, often providing more relief from symptoms. Neuropt

• Make it fun and novel. People stick with programs that include games, puzzles, new skills, and “brain-teasers.” krysalisconsultancy.co.uk+1

• Track it. Use a simple log that includes exercise, reps/minutes, difficulty (on a scale of 0–10), symptoms (on a scale of 0–10), and notes.

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Sample 2-week progression (printable idea)

Week 1

• Aerobic: Walk for 10–15 minutes, 4 days a week.

• Strength: Sit-to-stand 2×8; rows 2×10; wall push-ups 2×8, 2 days.

• Balance: Feet together ? semi-tandem (20–30 sec holds), 5 rounds, 3 days.

• Vestibular: VOR x1 (2×15 sec each direction), 5 days.

• Cognitive: 10–15 min journal and 1 app module daily; non-dominant-hand task 3x/week.

Week 2

• Aerobic: 18–25 min, add a light 2:1 interval on 2 days.

• Strength: Add a third set; step-ups, 2 sets of 8 reps per leg.

• Balance: Add tandem stance and heel-to-toe walking, 2 passes.

• Vestibular: Increase VOR to 3×20 sec and add slow head turns during walking.

• Cognitive: Add spaced-retrieval practice (names, appointments) and a new puzzle.

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Frequently asked questions

Q: How hard should cardio feel?
A: Aim for easy to moderate (you can talk in full sentences). If symptoms rise above your usual level, back off and try again later. Neuropt

Q: Can I do strength and balance on the same day?
A: Yes—just keep total training time reasonable and avoid stacking two “hard” sessions back-to-back until your tolerance grows. Physiopedia

Q: I feel wobbly with my eyes closed. Is that normal?
A: Many people with head injuries rely on vision for balance. Training under safe conditions (with a counter nearby and a caregiver watching) helps rebuild somatosensory and vestibular reliance. headway.org.uk

Q: What if words are hard to find?
A: Short, frequent speech drills (syllables, reading aloud) and simple language tasks can help—ideally with a speech-language pathologist guiding progress. Great Speech

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Bottom line

A comprehensive head-injury rehab plan incorporates aerobic, strength, balance/vestibular, coordination, and cognitive exercises—tailored to individual symptoms and progressively advanced over time. Layer in integrative chiropractic support when migraines, neck pain, or dizziness limit your training. The dose and consistency you can sustain are what unlock neuroplastic recovery.

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References

American Physical Therapy Association, Section on Neurology. (n.d.). Exercise after traumatic brain injury (factsheet). https://www.neuropt.org/docs/default-source/brain-injury-sig/bi-sig/exercise_after_tbi.pdf Neuropt

Cleveland Clinic. (n.d.). Vestibular rehabilitation therapy: What it is & exercises. https://my.clevelandclinic.org/health/treatments/15298-vestibular-rehabilitation Cleveland Clinic

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

Flint Rehab. (2024, February 15). Cognitive rehabilitation exercises to sharpen your mind. https://www.flintrehab.com/cognitive-exercises-tbi/ flintrehab.com+1

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

Galeno, E., & coworkers. (2022). Effectiveness of vestibular rehabilitation after concussion: A systematic review of randomized controlled trials. International Journal of Sports Physical Therapy. https://pmc.ncbi.nlm.nih.gov/articles/PMC9819464/ PMC

Great Speech. (2020, August 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+1

Han, B. I., Song, H. S., & Kim, J. S. (2011). Vestibular rehabilitation therapy: Review of indications, mechanisms, and key exercises. Journal of Clinical Neurology, 7(4), 184–196. https://pmc.ncbi.nlm.nih.gov/articles/PMC3259492/ PMC

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

Krysalis Consultancy. (2020). Over 200 home activities for brain injury survivors and their families. https://www.krysalisconsultancy.co.uk/resources/item/over-200-home-activities-for-brain-injury-survivors/ krysalisconsultancy.co.uk

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

State of Illinois—Be Well Illinois. (2025). Traumatic brain injury recovery: Full-body & cognitive TBI exercises to try at home. https://cms.illinois.gov/benefits/stateemployee/bewell/getmoving/traumatic-brain-injury-recovery.html CMS Illinois

Zaker Chiropractic. (2025). Integrating chiropractic care into your head injury rehabilitation plan. https://zakerchiropractic.com/chiropractic-care-head-injury-rehabilitation/ zakerchiropractic.com

Dr. Alexander Jimenez, DC, APRN, FNP-BC. (n.d.). El Paso, TX chiropractor & personal injury specialist (integrative care portal). https://dralexjimenez.com/ El Paso, TX Doctor Of Chiropractic