What are the Six Stages of Concussion Recovery?

The normalization of concussions in sports has athletes returning to competition sooner and sooner these days. The truth is concussions should always be handled with care, as there are several stages of the recovery process. Knowing how to recognize a concussion and how to properly reintegrate into regular activities and sports is important to ensure safety in the days, weeks, months and years ahead. 

We spoke with Paul Allegra, M.D., an orthopedic surgeon with INTEGRIS Health in Edmond, about how to recognize a concussion and what next steps to take.

What happens during a concussion?

The brain is among the most essential and complex organs in the human body. Any sort of injury to the head – whether it affects the 22 bones that form the skull to protect the brain or the cells, nerve fibers and blood vessels within the brain – has the potential to cause changes in brain function.

A concussion is a prime example of this. This type of mild traumatic brain injury (TBI) occurs when a head injury (either a bump, violent jolt or blow) causes the brain to rapidly move back and forth. The quick and sudden force prompts the brain to bounce off the skull, which stretches and damages nerves and blood vessels. 

Several things can then occur that create a temporary loss in normal brain function.

The brain has billions of neurons that send messages throughout your body. If a concussion damages these neurotransmitters, various tasks can be disrupted such as your memory, speech and motor skills. Swelling and inflammation can also temporarily lead to symptoms. 

The most common concussion symptoms include headaches, issues with balance and coordination, confusion, sleep disturbances and visual processing issues.
Although concussions are often associated with contact sports, such as football, basketball, soccer and hockey, they also occur in everyday life. Examples include car accidents, bike accidents, physical abuse and falls in younger children or older adults.

Concussion recovery time

Typically, concussion symptoms can last for several days up to a couple weeks. However, in some cases, symptoms may linger for months. Examples include undiagnosed, unrecognized or poorly treated concussions that can take months to heal from.

Despite damage to such sensitive areas of the body, the brain has a remarkable ability to repair itself. A process known as neuroplasticity allows the brain to rewire and create new neural connections after sustaining damage. At the same time, cellular repair helps regenerate new cells to replace damaged cells.

Additionally, while inflammation has a negative connotation, the inflammation created by the brain following a concussion is actually a regulatory response to prevent excessive damage and promote healing.

These healing mechanisms, along with rest and recovery, can help you become symptom-free in a short period of time.

“Concussions need to be respected as serious injuries. While they may be difficult to diagnose in patients with mild symptoms, a high index of suspicion must be maintained, and any signs of concussion should prompt immediate removal from sports. Concussions represent roughly 5-9% of all sports injuries, and traumatic brain injuries (TBI) are a leading cause of sport-related death in the U.S.,” Allegra says.

Six stages of concussion recovery

Whenever you suffer a concussion, your body progresses through a series of phases starting with the acute phase, the recovery phase and the post-acute recovery phase. The acute phase includes the immediate onset of symptoms. Rest is needed during this phase so the brain can heal. As symptoms begin to improve, you enter the recovery phase in which you begin to ramp up your activities. Light activity will eventually progress into moderate and strenuous activity. In the post-acute recovery stage, you are fully recovered and can return to normal activities such as playing sports, going to school or returning to work.

While these phases can apply to anyone who suffers a concussion, people playing athletes often follow a more detailed six-stage recovery process to return to competition. You can learn more by reading concussion recovery guidelines set forth by the Centers for Disease Control and Prevention: 

1. Return to regular activities: For children and teenagers, this would mean a return to school. For non-students, this first step could include short walks or returning to work. 
2. Light aerobic activity: Light activity includes biking or light jogging. Avoid lifting weights as it can place too much strain on the body during the recovery process.
3. Moderate activity: Moderate activity includes more intense bike rides, running or light weightlifting.
4. Heavy, non-contact activity: Heavy activity includes regular weightlifting, sprinting, biking at a high intensity and any other activity that doesn’t involve contact. For football players, this stage usually involves wearing a red non-contact jersey to avoid any hits.
5. Practice and full contact: The final step before game action involves practicing in a full capacity. This allows your medical team to make sure the brain is fully recovered.
6. Competition: Clearance for full activity is obtained from a health care provider. You can now compete in games.

When can you return to activities?

Conservatively, you can expect to return to your regular activities in 14 to 21 days. Ultimately, though, it depends on when symptoms end. For example, you should not only be free of symptoms at rest but also free of symptoms when exercising. This also applies to mental activities.

These days, most organizations or schools have specific criteria to return to activities. The most common tool is an evaluation called Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test. This 30-minute computer-based test measures aspects of your cognitive function. A physical exam or balance test can also be accompanied by the imPACT evaluation.

Avoiding second impact syndrome

Going through the proper recovery process is important because it reduces the risk of suffering a second concussion before the brain has recovered, which is known as second impact syndrome.

When a concussion occurs, the brain is fragile and more vulnerable to injury while it heals. Specifically, intracranial pressure increases due to the brain's inability to properly regulate blood flow. As a result, a hit to the head can cause severe swelling.

Suffering a concussion before the initial brain injury heals can make symptoms linger for months. It also increases the risk of the symptoms becoming permanent. For example, concentration and memory issues can turn chronic if you experience second impact syndrome.

If you or a loved one suffer a concussion, request an evaluation from a provider who specializes in concussions. Beyond establishing the severity of the injury, they can help draw up an appropriate treatment plan. Athletes shouldn’t resume participating in competition until all symptoms have completely subsided and they regain their normal physical and cognitive abilities.

INTEGRIS Health Medical Group now offers a Saturday sports medicine clinic, open 9 a.m. to noon. No appointments are necessary, just walk right in. Visit our website to learn more.