More Than a Bump on the Head: Why Expert, Collaborative Care Matters in Concussion Recovery

Whether it happens from a fall, a car accident, or an impact on the sports field, a concussion disrupts the way your brain normally functions. Often classified as a mild traumatic brain injury (mTBI), a concussion occurs when a sudden force to the head or body causes the brain to shift rapidly within the skull.

Sport-related concussion is a traumatic brain injury caused by a direct blow to the head, neck or body resulting in an impulsive force being transmitted to the brain that occurs in sports and exercise-related activities. This initiates a neurotransmitter and metabolic cascade, with possible axonal injury, blood flow change and inflammation affecting the brain. Symptoms and signs may present immediately, or evolve over minutes or hours, and commonly resolve within days, but may be prolonged. (6th International Conference on Concussion in Sport – Amsterdam, Oct 2022) (Patricios et al., 2023).

Concussions in Older Adults

Concussions pose a significantly higher risk and often require longer recovery timelines for older adults. Due to age-related changes in blood vessels and brain tissue, seniors are far more susceptible to complications like intracranial brain bleeds. Additionally, a previous head injury can impair balance and gait, drastically increasing the likelihood of subsequent falls and compounding trauma.

Diagnostics & Neuroimaging

Because concussions disrupt brain function on a microscopic level rather than causing visible structural damage, they do not register on standard CT or MRI scans. Instead of relying on imaging, doctors perform comprehensive clinical evaluations—assessing memory, cognitive processing, visual function, balance, and reflex responses to accurately diagnose the injury.

No abnormality is seen on standard structural neuroimaging studies (computed tomography or magnetic resonance imaging T1- and T2-weighted images), but in the research setting, abnormalities may be present on functional, blood flow or metabolic imaging studies. Sport-related concussion results in a range of clinical symptoms and signs that may or may not involve loss of consciousness. The clinical symptoms and signs of concussion cannot be explained solely by (but may occur concomitantly with) drug, alcohol, or medication use, other injuries (such as cervical injuries, peripheral vestibular dysfunction) or other comorbidities (such as psychological factors or coexisting medical conditions). (6th International Conference on Concussion in Sport – Amsterdam, Oct 2022) (Patricios et al., 2023).

Overlapping Clinical Profiles

Concussions don't just happen on the field. At our clinic, we routinely see patients following motor vehicle accidents, recreational activities like martial arts or dance, and slips or falls in older adults. Every concussion is shaped by the mechanism of injury, age, and individual health history.

A diagnosis of a concussion is not a "one-size-fits-all". Its presentation is inherently complex because a direct or indirect blow to the head can disrupt multiple interconnected neurological systems—including vision, vestibular function, cognition, neck, and autonomic nervous system regulation.

Because two individuals with a concussion can present with completely different symptoms, a comprehensive clinical evaluation is essential. Rather than simply diagnosing a "concussion," the evaluation aims to identify which clinical profile(s) the individual is presenting with.

Figure 1

Overlapping clinical profiles: an emerging concept to facilitate individualised management after sport-related concussion. Most patients have features of multiple profiles. HA, headache; SCAT, Sports Concussion Assessment Tool.

Note. From “American Medical Society for Sports Medicine position statement on concussion in sport,” by K. G. Harmon et al., 2019, British Journal of Sports Medicine, 53(4), 213–225. https://doi.org/10.1136/bjsports-2018-100338

Evidence-Based Recovery & Return-to-Play Guidelines

As per the American medical society guidelines, consensus guidelines endorse 24–48 hours of symptom-limited cognitive and physical rest followed by a gradual increase in activity, staying below symptom-exacerbation thresholds.

Recovering from a concussion does not mean lying in a dark room until all your symptoms are gone, the science has changed! Research now shows that strict, total rest isn't helpful—and can actually slow down your recovery.

Here is what you should do instead:

• The First 24 to 48 Hours (Take It Easy): Stick to light, everyday activities around the house and limit screen time (phones, TVs, computers). Think of this as "relative rest"—relaxing, but not hiding in the dark.

• Day 2 Onward (Start Moving Gently): After the first day or two, gentle movement like walking or riding a stationary bike is highly recommended. As long as it only causes mild symptoms at most, getting your blood flowing actually speeds up brain healing! Just avoid activities with a risk of falling or hitting your head.

• Safe Exercise & Activity Rules: A slight increase in symptoms—up to 2 points higher on a 0–10 scale lasting under 1 hour—is safe and will not delay recovery.

• When to Stop: If symptoms spike by more than 2 points or last longer than an hour, stop the activity immediately.

• When to Restart: Rest until symptoms return to their baseline level before trying again.

• Rethink Screen Time: Cutting back on screens is super helpful for the first 48 hours, but you don't need to avoid them forever. After two days, you can gradually bring screens back into your routine as tolerated.

• Listen to Your Body: You can slowly step up your exercise intensity day by day. If yesterday's light walk felt fine, try walking a little faster or longer today!

  
  

Core Rules for Return-to-Play:

• Complete Recovery First: Athletes must be totally symptom-free at rest, during exercise, and after exercise before fully returning to play.

• Normal Test Results: An athlete needs a clean neurological checkup with normal memory, thinking, and balance tests (ideally matched against their pre-injury baseline scores).

• Step-by-Step Progression: Once cleared by a medical professional, the athlete gradually ramps up activity in stages—moving from light exercise to sport-specific drills, and finally back to full-contact practice.

  
  

Persistent Postconcussive Symptoms (PPCS)

Postconcussion syndrome or disorder is a term that has been frequently used to describe patients with lingering symptoms after a sport-related or recreation-related concussion, but often those patients do not meet the diagnostic criteria for these diagnoses. A preferred term is persistent postconcussive symptoms (PPCS), defined as symptoms that persist beyond the expected recovery time frame (>2 weeks in adults, >4 weeks in children). Persistent symptoms do not necessarily represent ongoing concussive injury to the brain.

The symptoms may involve neck pain, migraine and headaches, cognitive and psychological difficulties, balance disturbances, sleep disturbance; dysautonomia, including orthostatic intolerance and postural orthostatic tachycardia syndrome vestibular and oculomotor issues.

The Multidisciplinary Care Team

A team of different medical specialists is needed to figure out what is causing a person's ongoing concussion symptoms and how severe they are. This team may include: Sports Medicine Physician, Neurologist, Physiatrist (PM&R Doctor), Neurologic & Vestibular Physical Therapist, Vision Therapist, Neuropsychologist, and Psychologist / Psychiatrist.

A Neurologic Physical Therapist will perform a comprehensive evaluation to help assess the following impairments across key physiological domains:

• Vestibular-Ocular Function: Utilizing the standardized VOMS (Vestibular/Ocular-Motor Screening) protocol to evaluate gaze stability, smooth pursuit, saccades, and convergence.

• Cervical Spine Integrity: Assessing upper cervical biomechanics and soft-tissue involvement contributing to headaches & cervicogenic symptoms.

• Autonomic & Exertional Readiness: Testing for autonomic dysfunction and prescribing sub-symptom aerobic exercise using protocols like the Buffalo Concussion Treadmill Test.

• Balance & Postural Control: Measuring static and dynamic balance under varying sensory conditions.

• Psychological & Symptom Load: Screening for mood shifts, stress, and sleep disruption to address emotional and cognitive recovery.

To prevent symptom overload, evaluations are often paced across multiple visits.

Shared Decision-Making in Concussion Management

When deciding on a return to sports or prior activity levels after a concussion, medical providers and patients must engage in shared decision-making. This ensures every person makes an informed, personalized choice about their health.

Key elements of this process include:

• Patient & Caregiver Involvement: Decisions must factor in the person’s personal preferences, emotional readiness, and risk tolerance. For children and teens, parents or guardians must be fully involved.

• Gain Knowledge: Partnering with a healthcare professional to understand your concussion recovery roadmap takes the guesswork out of healing—empowering you to track your progress and confidently take control of your recovery.

• Balanced Risk Assessment: The conversation weighs the medical risks of playing against the psychological and physical benefits of sports.

• Multidisciplinary Input: Recommendations should consider the whole picture—incorporating insights from a team of specialists, the specific sport, injury severity, and cultural context.

  
  

Taking the Next Step

Navigating the aftermath of a concussion—especially when dealing with persistent post-concussion symptoms or complex profiles—can feel overwhelming, but you do not have to manage it alone. Because no two brain injuries are identical, full recovery relies on a tailored, collaborative approach. Partnering with dedicated concussion specialists ensures every aspect of your symptom profile is evaluated with precision, and targeted interventions are planned to assist with recovery.

Our clinic has guided countless patients through personalized, multidisciplinary treatment plans, turning complex symptoms into stories of complete, lasting recovery. Reclaiming your daily life, focus, and physical well-being begins with having the right expert team in your corner. If you or a loved one are struggling with lingering symptoms, schedule a consultation with our specialist team today to take the first step toward your recovery.

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References

Patricios, J. S., Schneider, K. J., Dvorak, J., Ahmed, O. H., Blauwet, C., Cantu, R. C., Davis, G. A., Echemendia, R. J., Makdissi, M., McNamee, M., Meeuwisse, W. H., McCrory, P., Premji, Z., Putukian, M., Broshek, D. K., Bryce, T. N., Buroker, R., Raftery, M., & Zemek, R. (2023). Consensus statement on concussion in sport: The 6th International Conference on Concussion in Sport–Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695–711. https://doi.org/10.1136/bjsports-2023-106898

Harmon, K. G., Clugston, J. R., Dec, K., Hainline, B., Herring, S. A., Kane, S. F., Kontos, A. P., Leddy, J. J., McCrea, M., Poddar, S. K., Putukian, M., Wilson, J. C., & Roberts, W. O. (2019). American Medical Society for Sports Medicine position statement on concussion in sport. British Journal of Sports Medicine, 53(4), 213–225. https://doi.org/10.1136/bjsports-2018-100338

Quatman-Yates, C. C., Hunter-Giordano, A., Shimamura, K. K., Landel, R., Alsalaheen, B. A., Hanke, T. A., McCulloch, K. L., Altman, R. D., Beattie, P., Berz, K. E., Bley, B., Cecchini, A., Dewitt, J., Ferland, A., Gagnon, I., Gill-Body, K., Kaplan, S., Leddy, J. J., McGrath, S., ... Silverberg, N. (2020). Physical therapy evaluation and treatment after concussion/mild traumatic brain injury. Journal of Orthopaedic & Sports Physical Therapy, 50(4), CPG1–CPG73. https://doi.org/10.2519/jospt.2020.0301

Academy of Neurologic Physical Therapy. (2021, July). Concussion clinical practice guideline: Examination recommendations [Clinician resource]. American Physical Therapy Association. https://neuropt-website-documents.s3.amazonaws.com/docs/default-source/cpgs/concussion/concussion-kt-clinician-resources/venn-diagram-examination-final-july-2021.pdf

Academy of Neurologic Physical Therapy. (2021, July). Concussion clinical practice guideline: Intervention recommendations [Clinician resource]. American Physical Therapy Association. https://neuropt-website-documents.s3.amazonaws.com/docs/default-source/cpgs/concussion/concussion-kt-clinician-resources/venn-diagram-intervention-final-july-2021.pdf

Concussion Alliance. (n.d.). What happens to your brain when you get a concussion? https://www.concussionalliance.org/what-happens-to-your-brain