Concussions are all too common, and all too often written off as minor injuries. In the past it was custom for doctors to quote old text books that “most concussions will clear up in about two weeks,” but more current research and the latest medical literature seems to prove otherwise. Research looking at persistent post-concussive symptoms (PPCS) points to a need for a dramatic shift in the way we view even mild traumatic brain injuries.
According to a study published in 2022 in the Frontiers in Neurology, approximately 15–30% of concussions result in symptoms continuing for four weeks or more post-injury in children, youth, and adolescents. In adults, similar percentages of patients can find themselves with PPCS lasting three months or more
Also called post-concussion syndrome (PCS), patients with this condition will experience recovery period that is more like weeks to months. The study notes that these symptoms may include headaches, dizziness, problems with concentration and memory—as well as mental health issues such as depression and anxiety.
Less Than Half of Sports-Related Concussions Recover Fully Within two Weeks
In research conducted by the University of Michigan, the recovery times of nearly 1,700 athletes with concussions were analyzed. While normal return-to-play time (which is based on the time it takes for 50% of people to have recovered from their concussions) had previously been set at 14 days, the study suggests that 28 days is a more accurate projection for the process of full concussion recovery. The study notes that at the 28-day point, 85% of the athletes had returned to play.
In similar results of a New Zealand Sports Concussion Clinic study published in 2020 in the Clinical Journal of Sport Medicine, researchers said of the 594 participants analyzed, less than half (45%) showed full clinical recovery in less than two weeks. As stated by the study authors: “We believe that…recovery rates may be slower than previously reported.” They further write that “given increasing data suggesting that many people have a more prolonged recovery, more conservative recommendations may need to be made in future consensus statements.”
Even Mild Concussions Can Take Longer Than 2 Weeks for Full Recovery
A concussion is the common term used to describe a mild traumatic brain injury (TBI). Concussions usually happen after a blow to the head, but they can also occur with violent shaking and movement of the head or body. Contrary to what we see in movies and on TV, you don’t have to lose consciousness to get a concussion or experience persistent post-concussive symptoms, says Medical Director and founder of Mid-Atlantic Concussion (MAC) Alliance, Vincent Schaller, MD, DABFM, CIC. “In fact, the risk of developing PPCS doesn’t have to be associated with the apparent severity of the initial injury.”
It’s Time to Stop Calling Concussions “No Big Deal”
“Calling a concussion a mild traumatic brain injury, or mTBI, is doing a huge disservice to patients,” says Dr. Schaller. “Even a mild concussion can have severe symptoms and result in long-term post-concussion syndrome, because there are so many factors that come into play when the brain is injured.”
Factors can include:
- Age
- The location of the impact on the brain
- The number of previous concussions and TBIs
- How the head is positioned on the neck at the time of the injury
- A history of migraines
- Having ADHD
- History of depression, anxiety, other mental health issues
- Other pre-existing medical conditions, especially pre-existing neurological conditions such as epilepsy, Parkinson’s disease, multiple sclerosis, tremors, etc.
“Each concussion is unique because each person and each impact on the brain is different, and there is no cookie-cutter fix that works for every single patient,” says Dr. Schaller. “A concussion is a TBI, period. Its severity is best determined by objectively measuring visual and cognitive deficits along the way to recovery,” he adds.
Post-Concussive Symptoms in Early Childhood Should Not Be Overlooked
A 2024 Canadian research study published in JAMA Network Open followed 303 children aged 6 months to six years with early childhood concussions, with orthopedic injuries or without injury. The researchers found that early childhood concussions can result in significantly elevated post-concussive symptoms that can still be present three months after the injury. The children suffering from PPCS displayed symptoms such as inattention, slowing down, headache, nausea, imbalance, fatigue and drowsiness, poor sleep, vision problems, light and noise sensitivity, and irritability. Because children under the age of 6 tend to have more limited verbal and cognitive abilities, the researchers suggested using developmentally appropriate screenings and assessments to track post-concussive symptoms to aid in the diagnosis in young children.
Concussion Recovery Expectations Need a Reality Check
When it comes to youth sports, parents, coaches and athletes should know that taking longer than 14 days to recover from a concussion can be perfectly normal. The same goes for employers, co-workers, friends and family members of concussed adults, says Dr. Schaller. Changing expectations may help eliminate social pressure that might convince athletes, coaches or parents to allow for a return to normal activity before the concussion patient has really fully recovered.
From the first moment of injury, we need to have these more reasonable expectations for concussion recovery. That’s because sometimes symptoms don’t present themselves right away.
“Even if a patient is asymptomatic, they shouldn’t immediately resume normal activities,” says Dr. Schaller. “We need to make sure the brain heals fully. If we don’t, there is a very real risk of plunging the patient back into a situation where additional injury could occur before the first concussion was properly healed.”
Modern Technology Has Taken the Guess Work Out of Concussion Diagnosis and Treatment
In assessing TBIs, MAC Alliance uses advanced brain health testing technologies and concussion protocols. The testing tools include:
- ImPACT neurocognitive testing
- Cambridge Brain Sciences (CBS Health) neurocognitive testing
- BrainScope One quantitative EEG
- RightEye infrared eye tracking
- Brain SPECT Scan 3-D metabolic imaging
- Sway Balance System mobile-app-based vestibular screening for cell phones and tablets
We also use these tools to monitor how patients’ recovery programs are working, and allow us to customize each to address individual needs. “We also utilize brain SPECT scan technology in some of our toughest concussion and TBI cases,” says Dr. Schaller.
Through a partnership with Amen Clinics, we now can provide Single Photon Emission Computed Tomography, or SPECT, to our patients. Amen Clinics has built the world’s largest database of SPECT brain scans (over 200,000 to date) to help patients with a wide variety of cognitive and mental health issues, as well as detecting areas of brain injury from trauma, hypoxia, toxic exposure, etc.
Where to Find a Concussion Specialist in the Mid-Atlantic Region
To date, MAC Alliance has treated over 15,000 patients in Delaware, Pennsylvania, Maryland, New Jersey, Virginia, New York and beyond. To find a MAC Alliance Concussion Care Center near you, please use our easy-to-use location finder or call (302)235-8808.
[POST UPDATED 05/17/24]
