What is a Concussion?
A concussion is a mild traumatic brain injury (TBI) caused by a blow to the head or rapid acceleration/deceleration forces. This jolt disrupts normal brain function—temporarily. While concussions usually don’t cause structural brain damage like bleeding or swelling, they disrupt chemical balance, impair cellular function, and trigger metabolic changes [1,2].
They’re common in contact sports like football, rugby, boxing, MMA, and American football, but can also occur in non-contact sports and daily life.
Photo by Vladislav Igumnov on Unsplash
How Long Does a Concussion Last?
Most concussions resolve within 7 to 14 days, though some symptoms can persist beyond 28 days [3].
Recovery may take longer for those with prior concussions. For example:
- 30% of collegiate football players with 3+ concussions had symptoms lasting over a week, compared to 14.6% with only one prior concussion [3].
- Adults with higher PCSS scores (42.5 vs. 19.2, p<0.01) and more reported symptoms (13.9 vs. 8.9, p=0.008) were more likely to have prolonged symptoms [4].
In children aged 10–17, the median recovery was 17 days, with prolonged recovery more likely in:
- Athletes with 2+ prior concussions
- Those with higher symptom scores
- Females, who were nearly twice as likely to experience delayed recovery (OR = 2.08, CI = 1.49–2.89) [5]
Concussion Signs and Symptoms
Concussions show up in physical, cognitive, and emotional/behavioural ways.
Early symptoms may include:
- Headache
- Dizziness
- Mental fog or confusion
Within 24 hours, more symptoms may appear:
- Nausea
- Balance issues
- Vision problems
- Memory loss
- Fatigue [6]
Later symptoms can include:
- Sleep disturbances
- Anxiety
- Sensitivity to light/noise
- Irritability [7]
Note: Not every case presents the same way, especially in those with previous concussions [8].
Do Symptoms Differ by Age or Gender?
Yes.
- High school athletes perform worse on verbal and visual memory tests post-concussion.
- Female athletes report more symptoms and show greater visual memory impairment compared to males [9].
Concussion Causes
Concussions result from direct or indirect impact, with the brain rapidly moving inside the skull.
In a study of 2000+ athletes across 27 high school sports:
- 62.8% of concussions were due to player contact
- More common in males (59.1%) than females (39.8%)
- Equipment contact (especially with the ball) was the second most common mechanism
- American Football had the highest concussion rate at 9.21 per 10,000 athlete exposures (AE), much higher than the 3.89 per 10,000 AE average across sports
- Concussion rates spiked during competitions
- In comparable sports, females had higher concussion rates than males [10]
What are the Physical Signs of a Concussion?
Recognising concussion signs quickly is critical. The SCAT3 (Sport Concussion Assessment Tool, 3rd Ed.) is widely used for athletes aged 13+.
In a study on ice hockey players [11], five key on-field signs were:
- Disorientation (68%)
- Postural instability (44%)
- Vacant stare (41%)
- Amnesia (27%)
- Loss of consciousness (24%)
Many athletes showed multiple signs. Emotional instability (e.g., inappropriate laughing or crying) is another indicator [8].
How Harmful is a Concussion?
Most recover within a few weeks. But repeated concussions can lead to serious long-term effects.
In boxing, repeated brain trauma has been linked to conditions like:
- Punch-drunk syndrome
- Dementia pugilistica
- Chronic Traumatic Encephalopathy (CTE) [12]
Recent research also links football heading to higher dementia risk. Former pros are 3.5 times more likely to develop dementia than the general population [13].
While neurodegenerative risk varies by position and career length, the risks are independent of era [14].
As a result, The FA has trialed banning deliberate heading in U12 grassroots matches.
What are the 3 Stages of a Concussion?
1. Acute Phase (0–72 hours)
Symptoms peak during this time: headache, dizziness, nausea, confusion.
- Immediate rest from physical and mental activity is recommended
- Light walking may be introduced if symptoms don’t worsen
- Constant monitoring is essential [6,15]
2. Subacute Phase (~3 weeks)
Brain function is still recovering.
- Individuals may show reduced activation in attention networks early on
- Gradual return to physical/cognitive tasks is key
- Symptoms often begin to improve, but caution is needed [16]
3. Chronic Phase (Weeks to Months)
In some, symptoms persist longer than expected — a condition known as Post-Concussion Syndrome (PCS).
- May include headaches, anxiety, sleep issues, memory trouble
- PCS can last months to years and cause lasting cognitive impairments in attention, memory, and verbal learning [17]
How Long is Concussion Recovery?
Recovery times vary. Key factors include age, sex, injury severity, and medical history.
General Timelines
- Adults: Symptom recovery in 6 days, cognitive recovery in 5 days
- Adolescents/Children: Symptom recovery in 15 days, cognitive in 7 days [18]
Factors Affecting Recovery
- Older adults (>35) tend to recover more slowly [19]
- Females often experience more severe symptoms and longer recovery [19]
- Migraine history is linked to delayed recovery
- Psychological conditions (e.g., anxiety, depression) do not significantly delay recovery [19]
How to Speed Up Concussion Recovery?
While there’s no quick fix, certain strategies can help improve recovery outcomes:
1. Controlled Aerobic Exercise
Sub-threshold aerobic exercise (e.g., walking, cycling) accelerates recovery.
A clinical trial found those using this method recovered 4 days faster than a stretching group [20].
2. Phased Return-to-Play
Follow a structured, stepwise return to sport. Each stage should be symptom-free before progressing.
3. Nutrition
Nutrients like omega-3s and antioxidants may support brain healing [20].
4. Sleep Management
Sleep problems are common post-concussion and can slow healing. Prioritise good sleep hygiene [20].
5. Individualised Approach
Work with qualified professionals to develop recovery plans tailored to the athlete’s age, sex, symptoms, and history [19].
Conclusion
Concussions are a serious issue in sport. While most people recover within weeks, recovery can be longer depending on personal factors like age, gender, and prior history.
By understanding the three stages of concussion and using evidence-based strategies—such as controlled exercise, phased return-to-play, and individualised management—athletes, coaches, and medical staff can optimise outcomes.
As awareness grows, so too does our ability to manage concussion safely—balancing performance and long-term brain health.
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