New Frontiers in Concussion Care and Advances in Managment
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Key Facts
- Most concussions resolve within 2–4 weeks, but 10–30% of patients may experience lingering symptoms.
- Diagnosis is clinical and may be supported by tools like eye tracking and advanced imaging.
- Early, light aerobic exercise may speed recovery when introduced safely.
- Post-concussion syndrome involves symptoms lasting beyond 10–14 days.
- Repeated concussions increase the risk for CTE and long-term cognitive changes.
Concussions—also known as mild traumatic brain injuries (mTBIs)—have taken over the headlines in public health, especially in sports, pediatrics, and emergency medicine. A concussion is a complex physiological process that affects the brain, triggered by traumatic biomechanical forces. Despite being called “mild,” they’re not so mild. From headaches and confusion to vision problems and mood swings, concussions mess with your life in subtle ways. This article breaks down what we know about concussions, including how they’re diagnosed, managed, and what the latest science says about long-term outcomes.
Table of Contents
- Definition and Types of Mild Traumatic Brain Injury
- Clinical Presentation and Concussion Symptoms
- Pathophysiology
- Diagnosis and How to Diagnose Concussion
- Prognosis, Post Concussion Syndrome and Long-Term Outcomes
- Research Directions and Emerging Perspectives
- Closing Thoughts
- References
Definition and Types of Mild Traumatic Brain Injury
A concussion is a short-term disruption in brain function caused by an external force—most often a blow to the head. It’s a type of mild traumatic brain injury resulting from a head injury. This can happen during a football tackle, a bicycle fall, a car accident or even a slip on the ice [2]. The initial injury can be any event that causes trauma to the head.
What makes concussions tricky is they rarely show up on CT scans or MRIs. They don’t usually cause bleeding or visible structural injury, so diagnosis relies on what the patient feels and how they do on neurological exams. To diagnose concussion, clinicians use a combination of medical assessment, neurological exam and sometimes imaging to rule out more severe injuries.
Clinical Presentation and Concussion Symptoms
Recognizing the symptoms of a concussion is key to timely diagnosis and management. Concussion symptoms can vary widely but often show up as common symptoms in four categories:
- Physical: Headaches, dizziness, nausea, vomiting, blurry vision or light sensitivity
- Cognitive: Trouble concentrating, feeling mentally “foggy,” memory lapses
- Emotional: Mood swings, irritability, sadness or anxiety
- Sleep-related: Difficulty sleeping or sleeping too much [1,3,6]
Symptoms of a concussion and symptoms of concussion can be subtle, vary in severity and may not appear right away—symptoms can occur at different times, sometimes hours or even days later. Be on the lookout for warning signs and worsening symptoms such as repeated vomiting, severe headache, confusion or loss of consciousness which require immediate medical attention.If these symptoms get worse or last more than 10-14 days they are considered persistent symptoms and may develop into what’s called post-concussion syndrome or persistent post concussive symptoms—a long and frustrating recovery phase.
Pathophysiology
What’s actually happening in the brain? When the head hits, the brain moves rapidly inside the skull. This causes stretching of nerve fibers (axons), microscopic damage to brain cells and brain tissue, a sudden disruption in the brain’s energy supply—including changes in cerebral blood flow—and an inflammatory response. It’s like the brain gets rattled on a cellular level. Concussions often result in a temporary loss of normal brain function. In more severe cases complications such as severe swelling or brain swelling can occur, increasing intracranial pressure and life-threatening risks.
Newer models—including the 2025 theory of sensory-driven neurophysiological dysfunction—suggest that imbalances in how the brain processes sensory input may be the reason why some people don’t recover as quickly [9]. This explains why minor head injuries can have lingering effects like light sensitivity or motion-triggered dizziness.
Over time repeated concussions can add up. Chronic traumatic encephalopathy (CTE), a degenerative condition seen in some athletes and military veterans, is one of the more serious long-term risks [3,6].
Diagnosis and How to Diagnose Concussion
There’s no single test that can “prove” someone has a concussion. Diagnosis is clinical. Healthcare providers use symptom checklists, neurocognitive exams, balance testing and a detailed history to make the call [6,7]. It’s important to distinguish between minor head injury, minor head trauma and acute injury—while minor head trauma and minor head injury often refer to less severe cases like concussion, acute injury may indicate a more severe or immediate threat requiring urgent attention.
Patients with suspected concussion who show signs of serious injury such as worsening neurological symptoms or possible skull fracture should be evaluated in the emergency department for prompt diagnosis and management.But tools are being developed. Infrared eye-tracking technology is emerging as a non-invasive way to pick up on subtle visual disruptions that can follow a concussion [10]. Advanced imaging techniques like diffusion tensor imaging (DTI) can sometimes detect changes in white matter pathways but are still mostly for research or complex cases [1,3]. Imaging is used to rule out other injuries like skull fracture or more severe brain injuries that may mimic concussion symptoms.
Treatment and Rehabilitation
Acute Management
Total bedrest for a week is a thing of the past. Today’s concussion guidelines recommend:
- 24–48 hours of relative rest—meaning reduced physical and mental exertion
- Gradual reintroduction of daily activities like school or work based on symptoms [4,7]
Multimodal Treatment Strategies
Concussion recovery is no longer one size fits all. The current best practice is a customized, symptom-specific approach that may include:
- Osteopathic manipulative therapy (OMT) or vestibular rehab for balance and dizziness [1]
- Medications for headaches, nausea, sleep problems or mood symptoms
- Aerobic exercise therapy, started early but paced carefully, has been shown to speed up recovery [1,5]
- Vision therapy and occupational therapy for patients with eye strain or sensory overload [10]
A 2020 synthesis of practice guidelines recommends that care teams include physical therapists, mental health specialists and educational support when needed [8].
Prognosis, Post Concussion Syndrome and Long-Term Outcomes
The good news: most people feel better within 2-4 weeks. But for about 10-30% of people symptoms drag on much longer and develop into postconcussion syndrome and persistent symptoms that can last for weeks or months after the initial concussion.
Potential long-term complications:
- Ongoing memory or concentration issues
- Depression or anxiety
- In those with repeat concussion, repeat concussions or multiple concussions—especially college athletes and college football players—the risk of CTE increases [3,6]
- Previous concussion and previous concussions are risk factors for worse outcomes and longer recovery times* Sports concussions, sports related concussions and sport related concussion can lead to postconcussion syndrome and persistent symptoms especially in contact sports
Second impact syndrome and impact syndrome are rare but serious complications that can occur if a second concussion happens before full recovery from the initial concussion leading to rapid and potentially fatal brain swelling.
That’s why athletes, parents and clinicians are being told to take even “mild” head injuries seriously—and to avoid premature returns to contact sports. Recognizing risk factors like previous concussions and high-risk sports is key to prevention and management.
Research Directions and Emerging Perspectives
Concussion research is moving fast. Some key areas of focus:
- Developing standardized criteria for when someone is truly ready to return to play or school with input from sports medicine experts
- Improving objective testing tools like eye-tracking and advanced imaging
- Conducting long-term studies to track outcomes especially in youth and adolescents who may take longer to recover [2,10]
- Investigating the unique mechanisms and management of concussions from blast injuries especially in military and conflict settings
- Using systematic review methodologies to synthesize research findings and inform clinical guidelines for concussion management
In pediatric cases especially, providers are becoming more cautious and proactive in monitoring recovery and minimizing risk. Interdisciplinary collaboration within sports medicine is advancing prevention strategies, diagnosis and treatment for athletic populations.
A recent article in Frontiers in Neurology says individual variability in symptoms may be tied to how the brain processes sensory input—so we’re shifting the focus from what happened to how the brain responds afterward [9].
Closing Thoughts
Concussions are no longer a wait it out mentality. Thanks to ongoing research and evolving clinical guidelines care is becoming more proactive, individualized and holistic. From new diagnostic tech to personalized rehab plans we’re getting better at not just managing concussions—but helping people truly recover from them.
References
[1] Patel, H., Polam, S., & Joseph, R. (2024). Overview of Treatment Options for Mild Traumatic Brain Injury: A Literature Review. Cureus, 16(4), e59021. https://doi.org/10.7759/cureus.59021
[2] Hon, K. L., Leung, A. K. C., & Torres, A. R. (2019). Concussion: A Global Perspective. Seminars in pediatric neurology, 30, 117–127. https://doi.org/10.1016/j.spen.2019.03.017
[3] Patel, H., Polam, S., & Joseph, R. (2024). Concussions: A Review of Physiological Changes and Long-Term Sequelae. Cureus, 16(2), e54375. https://doi.org/10.7759/cureus.54375
[4] Marshall, S., Bayley, M., McCullagh, S., Velikonja, D., Berrigan, L., Ouchterlony, D., Weegar, K., & mTBI Expert Consensus Group (2015). Updated clinical practice guidelines for concussion/mild traumatic brain injury and persistent symptoms. Brain injury, 29(6), 688–700. https://doi.org/10.3109/02699052.2015.1004755
[5] Silverberg, N. D., Iverson, G. L., ACRM Brain Injury Special Interest Group Mild TBI Task Force members:, Cogan, A., Dams-O-Connor, K., Delmonico, R., Graf, M. J. P., Iaccarino, M. A., Kajankova, M., Kamins, J., McCulloch, K. L., McKinney, G., Nagele, D., Panenka, W. J., Rabinowitz, A. R., Reed, N., Wethe, J. V., Whitehair, V., ACRM Mild TBI Diagnostic Criteria Expert Consensus Group:, Anderson, V., … Zemek, R. (2023). The American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury. Archives of physical medicine and rehabilitation, 104(8), 1343–1355. https://doi.org/10.1016/j.apmr.2023.03.036
[6] Giza, C., Greco, T., & Prins, M. L. (2018). Concussion: pathophysiology and clinical translation. Handbook of clinical neurology, 158, 51–61. https://doi.org/10.1016/B978-0-444-63954-7.00006-9
[7] McCrea, M. A., Nelson, L. D., & Guskiewicz, K. (2017). Diagnosis and Management of Acute Concussion. Physical medicine and rehabilitation clinics of North America, 28(2), 271–286. https://doi.org/10.1016/j.pmr.2016.12.005
[8] Silverberg, N. D., Iaccarino, M. A., Panenka, W. J., Iverson, G. L., McCulloch, K. L., Dams-O’Connor, K., Reed, N., McCrea, M., & American Congress of Rehabilitation Medicine Brain Injury Interdisciplinary Special Interest Group Mild TBI Task Force (2020). Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines. Archives of physical medicine and rehabilitation, 101(2), 382–393. https://doi.org/10.1016/j.apmr.2019.10.179
[9] Krieger, D., Shepard, P., Kontos, A., Collins, M. W., Puccio, A., Eagle, S. R., Schneider, W., & Okonkwo, D. O. (2025). Sensory driven neurophysiological mechanisms of concussion: a parsimonious and falsifiable theory. Frontiers in neurology, 16, 1547786. https://doi.org/10.3389/fneur.2025.1547786
[10] Master, C. L., Scheiman, M., Podolak, O. E., Grady, M. F., & Howell, D. (2025). Metrics of concussion-related vision disorders among children and adolescents with persisting post-concussive symptoms using an objective eye tracking device. Journal of sport and health science, 101058. Advance online publication. https://doi.org/10.1016/j.jshs.2025.101058
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