Mild Concussion (mTBI) is Often Anything But


Until recently, the general discourse around concussion was that it is a mild head injury that will resolve on its own in a matter of days or weeks. That paradigm is changing as more research revealed confirms that a mild concussion can have long-term and ultimately permanent physical, emotional, and/or cognitive impacts on quality of life. 

There is a conundrum at play in the world of concussion recovery:

  • How does one define permanent as opposed to long-term? At three years post-injury? Ten years? Longer? 
  • Now, consider that concussion is assessed at the time of injury based on the presence and duration of loss of consciousness. How does this work when significant symptoms are delayed and persist? 

Scientists have been suggesting and considering this condundrum for decades and yet, little progress has been made in concussion assessment. To the millions of people who are living with post-concussion syndrome, these are rhetorical questions, and, a fact of life. PCS can be debilatating but it doesn't have to.

The previous, long-standing standard of care,  rest, cocoon, and do nothing, is no longer advised. The emergent standard of care for concussion treatment is a return to sub-threshold activity as early as 48-hours post-injury. This approach has been proven to substantially mitigate if not resolve symptoms which often become permanent following an extened period of inactivity. Hopefully will also bring about a change in concussion evaluation. 

If all concussions are treated as potentially life altering injuries and addressed with early active intervention, the number of those living with post-concussion syndrome would likely drop considerably. And, it makes sense, given that its impossible to tell if symptoms are permanent --- until they have been. 

Recommended Reading

Ahman, S., Saveman, B. I., Styrke, J., Björnstig, U., & Stålnacke, B. M. (2013). Long-term follow-up of patients with mild traumatic brain injury: a mixed-method study. Journal of rehabilitation medicine, 45(8), 758–764. https://doi.org/10.2340/16501977-1182

American Association of Neuro Surgeons: website 

Bazarian, J. J., & Atabaki, S. (2001). Predicting postconcussion syndrome after minor traumatic brain injury. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 8(8), 788–795. https://pubmed.ncbi.nlm.nih.gov/11483453

Brain Injury Association of America: Concussion Awareness

Dikmen, S. S., Machamer, J. E., Winn, H. R., & Temkin, N. R. (1995). Neuropsychological outcome at 1-year post head injury.Neuropsychology, 9(1), 80–90. https://doi-org.libproxy.uccs.edu/10.1037/0894-4105.9.1.80

Hadanny, A., & Efrati, S. (2016). Treatment of persistent post-concussion syndrome due to mild traumatic brain injury: current status and future directions. Expert review of neurotherapeutics, 16(8), 875–887. https://doi.org/10.1080/14737175.2016.1205487

Leddy. J.J, Haider, M., Ellis, M., et al. (2018) Exercise is medicine for concussion. Curr Sports

Med Rep. 2018;17(8):262-270.


Leddy, J., Baker,J., Willer,B. (2016) Physical Medicine and Rehabilitation Clinics of North America

Volume 27, Issue 2, May 2016, Pages 437-454

Mayer, A. R., Quinn, D. K., & Master, C. L. (2017). The spectrum of mild traumatic brain injury: A review. Neurology, 89(6), 623–632. https://doi.org/10.1212/WNL.0000000000004214

Mayo Clinic: Post-Concussion Symptoms

Mount Sinai Medical Center: What Impact Will Mild TBI Have on a Person's Life?

NIH. (2018, June 26). Many with mild traumatic brain injury don’t receive follow-up care. National Institutes of Health. https://www.nih.gov/news-events/nih-research-matters/many-mild-traumatic-brain-injury-dont-receive-follow-care

Permenter CM, Fernández-de Thomas RJ, Sherman Al. P
ostconcussive Syndrome. [Updated 2022 Aug 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534786/#

Ryan, L & Deborah L. Warden (2003) Post concussion syndrome, International Review of Psychiatry, 15:4, 310-316, DOI: 10.1080/09540260310001606692 

Theadom, A., Parag, V., Dowell, T., McPherson, K., Starkey, N., Barker-Collo, S., Jones, K., Ameratunga, S., Feigin, V. L., & BIONIC Research Group (2016). Persistent problems 1 year after mild traumatic brain injury: a longitudinal population study in New Zealand. The British journal of general practice : the journal of the Royal College of General Practitioners, 66(642), e16–e23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4684031/

Theadom A, Starkey N, Barker-Collo S, Jones K, Ameratunga S, Feigin V, et al. (2018) Population-based cohort study of the impacts of mild traumatic brain injury in adults four years post-injury. PLoS ONE 13(1): e0191655. https://doi.org/10.1371/journal.pone.0191655

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